Elevated fibrin clot strength (MA-CFF > 35 mm) assessed by thrombelastography was associated with a significantly higher risk of MACE at 6 months post-TAVR (HR 7.25; 95% CI 1.80-29.30; p<0.01).
Cohort (n=107)
No
Does hemostatic profiling using thromboelastography identify patients at risk for MACE and bleeding after TAVR?
Thromboelastography, specifically elevated fibrinogen markers, can identify post-TAVR patients at high risk for MACE, while low platelet reactivity predicts bleeding.
Effect estimate: HR 7.25 (95% CI 1.80-29.30)
p-value: p=<0.01
Abstract Introduction Patients after transcatheter aortic valve replacement (TAVR) have a high incidence of major adverse cardiac events (MACE) and bleeding. However, data on hemostatic markers for predicting these events are limited. Methods In this single-center prospective cohort study of patients undergoing TAVR from November 2020 to June 2022, the association of hemostatic profiles and clinical outcomes were assessed. The hemostatic profiling included thromboelastography (TEG), light transmission aggregometry (LTA), and conventional laboratory markers to measure thrombogenicity. The outcome was MACE (death, myocardial infarction, or stroke) and major/non-major clinically relevant bleeding at 6 months. Results Of the 107 patients included, 104 (97%) completed follow-up for clinical outcomes. At 6 months, 9% experienced MACE, and 10% had clinically relevant bleeding. Platelet-fibrin clot strength, reflected by the maximum amplitude (MA) in thrombelastography, was elevated in patients with MACE (per 1mm increase (MA-citrated kaolin): HR 1.26 1.02;1.56, p= 0.03). Fibrin's role in maximum clot strength was crucial, with elevated fibrinogen levels, increased citrated functional fibrinogen (MA-CFF), and faster fibrin formation (alpha-angleα) all associated with a higher risk of MACE (per 20 mg/dL fibrinogen increase: HR 1.15 1.02–1.28, p=0.02; per 5 mm MA-CFF increase: HR 1.59 1.12–2.26, p0.01; per degree α-citrated rapidTEG increase: HR 1.55 1.10–2.12, p=0.01). The optimal cut-off for MA-CFF in predicting MACE was determined to be 35 mm by ROC analysis. Kaplan-Meier analysis showed that patients with MA-CFF values above the cutoff of 35 mm had a significantly higher risk of MACE (HR 7.25 1.80; 29.30, p 0.01; Figure 1). Low on-treatment ADP-induced platelet reactivity assessed by LTA was associated with the risk of major and non-major clinically relevant bleeding at 6 months. (per 10% MA-ADP increase: HR 0.38 0.19; 0.75, p0.01). Conclusion Selected hemostatic markers identified the risk of major adverse cardiovascular events and bleeding within 6 months in post-TAVR patients, with fibrinogen identified as a key predictor.Kaplan Meier survival analysis
Hesselbarth et al. (Sat,) conducted a cohort in Transcatheter aortic valve replacement (TAVR) (n=107). Hemostatic profiling (thromboelastography) was evaluated on MACE (death, myocardial infarction, or stroke) and major/non-major clinically relevant bleeding at 6 months (HR 7.25, 95% CI 1.80-29.30, p=<0.01). Elevated fibrin clot strength (MA-CFF > 35 mm) assessed by thrombelastography was associated with a significantly higher risk of MACE at 6 months post-TAVR (HR 7.25; 95% CI 1.80-29.30; p<0.01).