Key result
In 25 patients undergoing TAVI, TEG platelet mapping demonstrated increased coagulation capacity and decreased platelet function, resulting in antithrombotic change for 3 days post-procedure.
Why the study?
Perioperative hypercoagulability during TAVI has been noted, but appropriate perioperative antithrombotic therapy remains controversial.
Observational (n=25)
TAVI induces an antithrombotic state for up to 3 days postoperatively, characterized by decreased platelet function despite increased coagulation capacity, suggesting a need to reconsider postoperative antiplatelet protocols.
Introduction The possibility of hypercoagulability during the perioperative period of transcatheter aortic valve implantation (TAVI) has been noted; however, there is still a controversy regarding the appropriate perioperative antithrombotic therapy. The study investigated coagulation and platelet functions during the TAVI perioperative period using thromboelastography (TEG) 6s platelet mapping. Methods A prospective observational study was conducted on 25 patients undergoing TAVI. TEG platelet mapping was performed at three time points: on admission to the operating room (before heparinisation), on postoperative day (POD) 1 and on POD 3. Perioperative changes observed included: maximum clot strength (MAHKH), clot strength without platelet function (MAActF), time to initiation of clots formation by coagulation factors (RHKH) and platelet function (Gp). Gp is activated by thrombin, and not affected by antiplatelet agents. It is calculated as [(5000×MAHKH)/(100 – MAHKH)] − [(5000×MAActF)/(100 – MAActF)]. Finally, MAADP/AA and GADP/AA, which reflect clot strength and platelet aggregation mediated by ADP/thromboxane A2 receptors, respectively, were also examined using the same method as for Gp. Results MAHKH continued to decrease until POD 3, indicating antithrombotic change after TAVI. Gp continuously decreased for 3 days after TAVI, while MAActF increased significantly on POD 3. Furthermore, RHKH shortened on POD 1 and POD 3, suggesting increased coagulation capacity after TAVI. Finally, GADP in clopidogrel-naive patients was reduced for 3 days after TAVI, while GAA in aspirin-naive patients showed no significant change perioperatively. Conclusions In this study involving TEG platelet mapping, coagulation capacity increased while platelet function decreased, resulting in antithrombotic change for 3 days after TAVI. The ADP receptor system may be implicated in the decreased platelet function. These results may be useful for considering optimal perioperative antithrombotic therapy in TAVI.
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Harada et al. (2022) conducted an observational in Patients undergoing transcatheter aortic valve implantation (TAVI) (n=25). Transcatheter aortic valve implantation (TAVI) vs. Baseline (before heparinisation) was evaluated on Changes in coagulation and platelet functions (MAHKH, MAActF, RHKH, Gp) evaluated with thromboelastography. In 25 patients undergoing TAVI, TEG platelet mapping demonstrated increased coagulation capacity and decreased platelet function, resulting in antithrombotic change for 3 days post-procedure.
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