Perioperative changes in coagulation and hemostasis assessed using thromboelastography and their association with hypoattenuated leaflet thickening after transcatheter aortic valve implantation: a retrospective, single-center observational study

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Severe aortic valve stenosis (n=30). Intervention: Hypoattenuated leaflet thickening (HALT) vs. No HALT. Primary outcome: Maximum amplitude for citrated rapid thromboelastography (CRT-MA) at post-anesthesia induction (T0) (MD -6, 95% CI -10 to -2, p=0.03).

Yasutaka Yamada; Daisuke Miura; Goro Yoshioka; Hiroshi Hongo; Nagi Hayashi; Junji Yunoki; Yoshiro Sakaguchi

doi:10.1186/s13104-026-08044-6

October 1, 2026BMC Research NotesOpen Access

Perioperative changes in coagulation and hemostasis assessed using thromboelastography and their association with hypoattenuated leaflet thickening after transcatheter aortic valve implantation: a retrospective, single-center observational study

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Key result

Lower baseline clot strength on rapid thromboelastography is linked to post-TAVI hypoattenuated leaflet thickening.

MD -6
95% CI -10 to -2
P=0.03
n=30

Why the study?

Perioperative changes in coagulation and hemostatic function during transfemoral TAVI and their association with hypoattenuated leaflet thickening have not been fully evaluated.

Are perioperative changes in coagulation and hemostasis assessed by thromboelastography associated with hypoattenuated leaflet thickening after TAVI?

Key Points

To evaluate perioperative changes in coagulation and hemostatic function using thromboelastography and assess their association with hypoattenuated leaflet thickening following transcatheter aortic valve implantation.
Retrospective, single-center observational study of 30 patients undergoing transfemoral transcatheter aortic valve implantation (TAVI).
Hemostatic function was evaluated using TEG6s at three time points: post-anesthesia induction before heparin (T0), post-protamine administration (T1), and postoperative day 1 (T2).
Hypoattenuated leaflet thickening (HALT) was evaluated using contrast-enhanced computed tomography 1 week after TAVI.
HALT was detected in 7 of 30 patients (23%), who showed significantly lower maximum amplitude (MA) across citrated rapid TEG, citrated kaolin with heparinase, and citrated kaolin at T0 and T2 (all adjusted p=0.03), and for citrated kaolin at T1 (adjusted p=0.03).
Clot kinetics (K) were significantly prolonged in the HALT group for citrated rapid TEG at T0 and T2 (both adjusted p=0.018) as well as citrated kaolin with heparinase and citrated kaolin at T2 (both adjusted p=0.03).
Fibrinogen levels were significantly lower in patients who developed HALT at T0 (p=0.02) and T1 (p=0.03), indicating that systemic hypercoagulability was absent.

Study Design

Type

Observational (n=30)

Multicenter

No

Structured PICO

Are perioperative changes in coagulation and hemostasis assessed by thromboelastography associated with hypoattenuated leaflet thickening after TAVI?

P

Population

30 patients (median age 84, 80% female) with severe aortic stenosis undergoing transfemoral TAVI, evaluated for perioperative coagulation changes and followed for 1 week.

E

Exposure

Thromboelastography (TEG) assessment at three perioperative time points (post-anesthesia induction, post-protamine administration, and postoperative day 1)

C

Comparator

Patients without hypoattenuated leaflet thickening (HALT)

O

Outcome

Hypoattenuated leaflet thickening (HALT) assessed using contrast-enhanced computed tomography 1 week after TAVIsurrogate

Main Result

Mean Difference: -6 (95% CI -10–-2)

Absolute Event Rate: 58% vs 64%

p-value: p=0.03

HALT after TAVI is associated with reduced clot strength and slower clot kinetics on perioperative TEG, suggesting that local hemodynamic factors rather than systemic hypercoagulability may drive its pathogenesis.

Limitations

Retrospective, single-center observational study with a small sample size
Causal relationships between perioperative thromboelastography parameters and the development of hypoattenuated leaflet thickening cannot be established
Changes in coagulation and hemostasis beyond the early postoperative period were not evaluated
Hypoattenuated leaflet thickening was assessed using postoperative computed tomography at a single time point
Unmeasured confounding factors, including patient frailty, inflammatory status, procedural factors, valve-related factors, and the intensity or adherence to antithrombotic therapy
Generalizability of findings to other centers should be interpreted with caution
Small sample size
Retrospective design
Single-center study
Exploratory nature requiring confirmation in larger prospective studies

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Answers are grounded in this paper and cite their sources.

Implication

HALT after TAVI may reflect local hemodynamics over systemic hypercoagulability; hypothesis-generating and should not yet change TEG-guided practice.

Abstract

To evaluate perioperative changes in coagulation and hemostatic function during transfemoral transcatheter aortic valve implantation (TAVI) using thromboelastography (TEG) and to investigate their association with hypoattenuated leaflet thickening (HALT). In this retrospective, single-center study, 30 patients undergoing transfemoral TAVI were evaluated using TEG6s at three time points: after anesthesia induction and before heparin administration (T0), after protamine administration (T1), and on postoperative day 1 (T2). HALT was assessed using contrast-enhanced computed tomography 1 week after TAVI. Seven patients (23%) developed HALT. After Benjamini–Hochberg correction, patients with HALT had significantly lower maximum amplitude values for citrated rapid thromboelastography (CRT), citrated kaolin with heparinase (CKH), and citrated kaolin (CK) at T0 and T2, whereas only CK maximum amplitude remained significantly lower at T1. CRT clot kinetics were significantly prolonged at T0 and T2, whereas CKH and CK clot kinetics were significantly prolonged at T2. CRT reaction time was significantly prolonged at T1. Fibrinogen levels were significantly lower in the HALT group at T0 and T1. These findings suggest that HALT is associated with reduced clot strength, slower clot kinetics, and lower fibrinogen levels during the perioperative period.

Discussion

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Cite This Study

Yamada et al. (2026) conducted an observational in Severe aortic valve stenosis (n=30). Hypoattenuated leaflet thickening (HALT) vs. No HALT was evaluated on Maximum amplitude for citrated rapid thromboelastography (CRT-MA) at post-anesthesia induction (T0) (MD -6, 95% CI -10 to -2, p=0.03). Patients who developed hypoattenuated leaflet thickening after TAVI exhibited significantly reduced perioperative clot strength, including a lower CRT-MA at baseline (MD -6), and slower clot kinetics.

synapsesocial.com/papers/6ac09b3a1652f928be545616 https://doi.org/10.1186/s13104-026-08044-6

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Perioperative changes in coagulation and hemostasis assessed using thromboelastography and their association with hypoattenuated leaflet thickening after transcatheter aortic valve implantation: a retrospective, single-center observational study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Perioperative changes in coagulation and hemostasis assessed using thromboelastography and their association with hypoattenuated leaflet thickening after transcatheter aortic valve implantation: a retrospective, single-center observational study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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