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Updated: Sep 10, 2025
Leveraging Turbidity and Thromboelastography for Complementary Clot Characterization
Published on: June 4, 2020
Platelet Reactivity and Fibrin Clot-Strength as assessed by TEG in Patients with Atrial Fibrillation undergoing
Diona Gjermeni1, Hannah Vetter2, Sofia Szabó2
1Department of Cardiology and Angiology, Faculty of Medicine, University Heart Center Freiburg - Bad Krozingen, University of Freiburg, Hugstetter Str. 55, 79106, Freiburg, Germany. Diona.gjermeni@uniklinik-freiburg.de.
Insights
High platelet reactivity (HPR) is common in atrial fibrillation patients undergoing percutaneous coronary intervention. Neither HPR nor low platelet reactivity predicted ischemic or bleeding risks in this group.
Area of Science:
- Cardiology
- Hematology
Background:
- Platelet reactivity (PR) in patients treated with clopidogrel undergoing percutaneous coronary intervention (PCI) is linked to ischemic and bleeding risks.
- Atrial fibrillation (AF) patients undergoing PCI often present unique challenges regarding thrombotic and bleeding complications.
Purpose of the Study:
- To investigate the association between platelet reactivity, global hemostasis, and clinical outcomes in patients with atrial fibrillation undergoing PCI.
- To determine if high platelet reactivity (HPR) or low platelet reactivity (LPR) predicts major adverse cardiovascular events (MACE) or bleeding in this patient cohort.
Main Methods:
- Thromboelastography (TEG) was performed on 168 patients between days 1-3 post-PCI.
- Patients were assessed for high platelet reactivity (HPR) and increased platelet-fibrin clot strength.
Main Results:
- The prevalence of HPR was high (60%) in the studied AF population undergoing PCI.
- HPR was not significantly associated with the composite outcome of MACE (HR 1.23 [CI 95% 0.43-3.49], p=0.700).
- A subset of patients (19.6%) with HPR and increased platelet-fibrin clot strength showed a trend towards higher ischemic risk (HR 2.83 [CI 95% 0.70-8.06], p=0.078).
Conclusions:
- Neither HPR nor LPR reliably predicted ischemic or bleeding risks in patients with AF undergoing PCI.
- Patients with AF undergoing PCI exhibit high rates of HPR.
- A combination of HPR and increased platelet-fibrin clot strength may indicate a higher risk for ischemic events, warranting further investigation.
Abstract:
Platelet reactivity (PR) in clopidogrel-treated patients undergoing percutaneous coronary syndrome (PCI) associates with ischemic and bleeding risk. The aim was to investigate the association of PR and global hemostasis with this risk in patients with atrial fibrillation (AF) undergoing PCI. TEG was performed on day 1-3 after PCI. 168 patients were included. Mean age was 79 years (IQR 72-82). 101 (60%) patients had high platelet reactivity (HPR). HPR was not associated with the composite outcome of MACE (HR 1.23 [ CI 95% 0.43-3.49], p = 0.700). 33(19.6%) patients had HPR and increased platelet-fibrin clot strength and showed a trend for association with higher ischemic risk (HR 2.83 [CI 95% 0.70-8.06], p = 0.078). Rates of HPR in patients with AF undergoing PCI were high. Neither HPR nor LPR predicted ischemic or bleeding risks. Patients with HPR and increased platelet-fibrin clot strength may be at higher risk for ischemic events.
