Assessment of platelet function during transcatheter aortic valve implantation

    Authors

    Keywords

    aortic stenosis, transcatheter aortic valve implantation, platelet reactivity, antiplatelet therapy

    DOI

    https://doi.org/10.15836/ccar2020.59

    Full Text

    Introduction : Recent studies described changes in platelet reactivity (PR) in days following transcatheter aortic valve implantation (TAVI). 1 However, precise time course and duration of these changes have not been fully investigated. Aim of the study was to investigate PR changes during and after TAVI. Patients and Methods : Study included 40 consecutive patients with severe and symptomatic aortic stenosis undergoing transfemoral TAVI procedure. Patients’ clinical characteristics were collected from medical records. All patients who did not have chronic dual antiplatelet therapy received loading dose of aspirin and clopidogrel (300 mg) one day before the procedure followed by their standard maintenance doses. PR was measured in seven time points: before start of procedure (T1), after heparin administration (T2), 10 minutes after valve implantation (T3), at the end of procedure (T4), and on 3 rd , 6 th and 30 th postoperative day (T5-7). PR was measured using impedance aggregometer in response to three platelet aggregation agonists using ASPI, ADP and TRAP test. Results : Mean patient age was 82.7 years with majority of patients being male 60% (N=25). All patients underwent successful transfemoral TAVI procedure using either self-expandable (N=25, 62.5%) or balloon-expandable valve. Mean postimplantation gradient was 9.97±4.44 mmHg. More than mild paravalvular regurgitation persisted in 2 (5%) patients. Values of PR in each tested time point are presented in Table 1 . There was no significant difference in PR between T1 and T2. After the valve implantation significant reduction of PR in all 3 tests was observed. PR continued to decline on consecutive measurements, with lowest values reached on 3 rd post-TAVI day (T5). On T6, value of ASPI test were not significantly different to the ones measured on T1, while values of ADP and TRAP test remained significantly lower. By 30 th post-TAVI day PR values reached levels not significantly different compared to T1. Conclusions : Presented results indicate that transfemoral TAVI induces transient decrease in PR regardless of the platelet activation pathway. Significant reduction of PR is observed 10 minutes after valve implantation with continuous decrease until 3rd day post-TAVI after which it is gradually increasing to pre-TAVI values.

    Cardiologia Croatica
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    Assessment of platelet function during transcatheter aortic valve implantation

    Extended Abstract
    Issue3-4
    Published
    Pages59
    PDF via DOIhttps://doi.org/10.15836/ccar2020.59
    aortic stenosis
    transcatheter aortic valve implantation
    platelet reactivity
    antiplatelet therapy

    Authors

    Zvonimir Ostojić*ORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Jure SamardžićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Saša PavasovićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Dubravka ŠipušORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Ivica ŠafradinORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Vlatka Rešković LukšićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Jadranka Šeparović HanževačkiORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Boško SkorićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Davor MiličićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Joško BulumORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

    Full Text

    Introduction : Recent studies described changes in platelet reactivity (PR) in days following transcatheter aortic valve implantation (TAVI). 1 However, precise time course and duration of these changes have not been fully investigated. Aim of the study was to investigate PR changes during and after TAVI. Patients and Methods : Study included 40 consecutive patients with severe and symptomatic aortic stenosis undergoing transfemoral TAVI procedure. Patients’ clinical characteristics were collected from medical records. All patients who did not have chronic dual antiplatelet therapy received loading dose of aspirin and clopidogrel (300 mg) one day before the procedure followed by their standard maintenance doses. PR was measured in seven time points: before start of procedure (T1), after heparin administration (T2), 10 minutes after valve implantation (T3), at the end of procedure (T4), and on 3 rd , 6 th and 30 th postoperative day (T5-7). PR was measured using impedance aggregometer in response to three platelet aggregation agonists using ASPI, ADP and TRAP test. Results : Mean patient age was 82.7 years with majority of patients being male 60% (N=25). All patients underwent successful transfemoral TAVI procedure using either self-expandable (N=25, 62.5%) or balloon-expandable valve. Mean postimplantation gradient was 9.97±4.44 mmHg. More than mild paravalvular regurgitation persisted in 2 (5%) patients. Values of PR in each tested time point are presented in Table 1 . There was no significant difference in PR between T1 and T2. After the valve implantation significant reduction of PR in all 3 tests was observed. PR continued to decline on consecutive measurements, with lowest values reached on 3 rd post-TAVI day (T5). On T6, value of ASPI test were not significantly different to the ones measured on T1, while values of ADP and TRAP test remained significantly lower. By 30 th post-TAVI day PR values reached levels not significantly different compared to T1. Conclusions : Presented results indicate that transfemoral TAVI induces transient decrease in PR regardless of the platelet activation pathway. Significant reduction of PR is observed 10 minutes after valve implantation with continuous decrease until 3rd day post-TAVI after which it is gradually increasing to pre-TAVI values.