Transcatheter aortic valve implantation significantly reduced total thrombogenic activity and platelet counts at 2 and 7 days post-procedure compared to baseline.
Observational (n=21)
No
Does transcatheter aortic valve implantation alter thrombogenic activity and platelet counts in patients with severe aortic stenosis?
TAVI transiently reduces total thrombogenic activity and platelet counts at 2 days post-procedure despite early improvements in HMW-vWF multimers, highlighting a potential mechanism for post-TAVI bleeding risk.
p-value: p=<0.01
Bleeding complications after transcatheter aortic valve implantation (TAVI) is a major problem in clinical practice. However, there is few information on thrombogenicity after TAVI. The aim of this study was to establish a monitoring of total thrombogenicity in perioperative TAVI using the Total Thrombus-formation Analysis System (T-TAS), a microchip-based flow chamber system for analysis of thrombus formation under flow condition. Twenty-three patients with severe aortic stenosis who underwent TAVI between August 2017 and March 2018 at Kumamoto university hospital were enrolled. After exclusion, data of 21 patients were analyzed. Blood samples were obtained before, 2, 7, and 30 days after TAVI. Thrombogenicity were assessed by the T-TAS to compute the area under the curve (AUC) (AR10-AUC30) in the AR chip. We also measured platelet count, high-molecular-weight von Willebrand factor (HMW-vWF) multimers, and plasma thrombopoietin. Computational fluid dynamics (CFD) analysis was performed to calculate the wall shear stress (WSS). The AR10-AUC30 levels and platelet counts were significantly lower at 2 days post-TAVI, and then increased gradually. HMW-vWF multimers, and plasma thrombopoietin, were significantly higher at 2 days post-TAVI, compared with before TAVI. CFD analysis showed that WSS of the aortic valve and posterior ascending aortic wall were significantly lower after TAVI than before-TAVI. Multivariate analysis identified max velocity measured by echocardiography, platelet count, and D-dimer as significant determinants of AR10-AUC30, representing total thrombogenicity. Although HMW-vWF multimers improved earlier after TAVI, total thrombogenic activity evaluated by T-TAS remained relatively low followed by improvement in thrombogenic activity at 30 days after TAVI. Clinical Trial Registration: https://clinicaltrials.gov. Unique identifiers: NCT03248232.
Ishii et al. (Thu,) conducted a observational in Severe aortic stenosis (n=21). Transcatheter aortic valve implantation (TAVI) vs. Baseline (before TAVI) was evaluated on Changes in thrombogenic activity evaluated by T-TAS (AR10-AUC30) at 2, 7, and 30 days after TAVI relative to baseline (p=<0.01). Transcatheter aortic valve implantation significantly reduced total thrombogenic activity and platelet counts at 2 and 7 days post-procedure compared to baseline.