Key result
Viscoelastic assays detect increased post-TAVI clot strength, with ROTEM quantifying heparin more consistently than TEG6s.
Why the study?
Sophisticated viscoelastic coagulation assessment has not been performed to characterise thrombotic changes in the TAVI setting, nor have the latest cartridge-based TEG and ROTEM systems been directly compared perioperatively.
How do the latest viscoelastic coagulation assays (ROTEMSigma and TEG6s) compare in characterizing thrombotic changes during transcatheter aortic valve implantation?
Observational
How do the latest viscoelastic coagulation assays (ROTEMSigma and TEG6s) compare in characterizing thrombotic changes during transcatheter aortic valve implantation?
ROTEM may be more reliable than TEG6s for quantifying heparin effects and assessing intraprocedural prothrombotic changes during TAVI.
Initial TEG/ROTEM profiling in TAVI; hypothesis-generating for periprocedural coagulation management.
BACKGROUND: Point of care viscoelastic measures with thromboelastography (TEG; Haemonetics Corporation, Switzerland) and thromboelastometry (ROTEM, Tem Innovations GmbH, Germany) now supersede laboratory assays in the perioperative assessment and management of coagulation. To the best of our knowledge, this sophisticated coagulation assessment has not been performed to characterise thrombotic changes in the transcatheter aortic valve implantation (TAVI) setting, nor have the two latest iteration cartridge-based systems been directly compared in the elective perioperative period. METHODS: Patients undergoing TAVI were prospectively recruited. Samples (n=44) were obtained at four timepoints (postinduction of anaesthesia, postheparin (100 IU/kg), postprotamine (1 mg/100 IU heparin) and 6 hours postoperatively). Each sample was concurrently assessed with standard laboratory tests (prothrombin time/international normalised ratio, activated partial thromboplastin time, thrombin clotting time, platelet count and direct fibrinogen, ROTEMSigma and TEG6s). RESULTS: Clot strength showed a statistically significant increase postheparin/TAVI deployment. When considering the subgroup of samples taken following the administration heparin, the heparinase channel of the TEG6s did not yield clotting strength results in 55% of samples and clotting time exceeded the upper limit of normal in 70% of samples. It was retrospectively recognised that the arachidonic acid channel of the TEG6s Platelet Mapping Cartridge had been decommissioned prohibiting assessment of aspirin effect. CONCLUSIONS: This study demonstrated a small intraprocedural prothrombotic change of uncertain clinical importance during the transcatheter aortic valve procedure. Further comparison with percutaneous coronary intervention and aortic valve replacement cohorts are needed to assess the merits of current antithrombotic guidelines, which are extrapolated from the PCI setting. The heparin effect was more consistently quantified by ROTEM.
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Fanning et al. (2021) conducted an observational in Transcatheter aortic valve implantation (TAVI). Point of care viscoelastic measures (TEG and ROTEM) vs. Standard laboratory tests was evaluated on Clot strength and clotting time. Viscoelastic coagulation assays demonstrated a statistically significant increase in clot strength post-TAVI deployment, with ROTEM more consistently quantifying the heparin effect than TEG6s.
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