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CC BY-NC-ND 4.0 · Thromb Haemost
DOI: 10.1055/s-0044-1790604
Cellular Haemostasis and Platelets

Dynamics of Thrombogenicity and Platelet Function and Correlation with Bleeding Risk in Patients Undergoing M-TEER Using the PASCAL System

Miriam Euper 
1   Department of Cardiology and Angiology, University Hospital Tübingen, Germany
,
Jürgen Schreieck
1   Department of Cardiology and Angiology, University Hospital Tübingen, Germany
,
Mareike Bladt
1   Department of Cardiology and Angiology, University Hospital Tübingen, Germany
,
Monika Zdanyte
1   Department of Cardiology and Angiology, University Hospital Tübingen, Germany
,
Andreas Goldschmied
1   Department of Cardiology and Angiology, University Hospital Tübingen, Germany
,
Manuel Sigle
1   Department of Cardiology and Angiology, University Hospital Tübingen, Germany
,
Dominick J. Angiolillo 
2   Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States
,
Diana A. Gorog 
3   Faculty of Medicine, National Heart and Lung Institute, Imperial College, London, United Kingdom
,
Mia Ravn Jacobsen
4   Departement of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
,
Rikke Sørensen
4   Departement of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
,
Dominik Rath
1   Department of Cardiology and Angiology, University Hospital Tübingen, Germany
,
Meinrad Gawaz
1   Department of Cardiology and Angiology, University Hospital Tübingen, Germany
,
Tobias Geisler
1   Department of Cardiology and Angiology, University Hospital Tübingen, Germany
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Abstract

Background Transcatheter mitral valve repair is performed in a patient population at risk for thrombotic and bleeding events. The effects on platelet function and reactivity and their association with bleeding events after mitral transcatheter edge-to-edge therapy (M-TEER) have not been systematically examined.

Objectives We sought to investigate the association of different parameters of platelet function and thrombogenicity with bleeding events post M-TEER.

Methods In this single-center study, 100 consecutive patients with mitral regurgitation receiving TEER were analyzed. Blood was taken directly from the guide-catheter in the left atrium before and after placing the device. Blood samples were analyzed using impedance aggregometry (Multiplate) and TEG6s. The results were compared pre- and postprocedural. The primary outcome was any bleeding complication according to the Bleeding Academic Research Consortium classification within 6 months.

Results A total of 41 patients experienced bleeding events. TEG analysis showed a significant decrease in ADP aggregation and increase in ADP inhibition. In ROC-analysis, TEG ADP aggregation and inhibition and Multiplate ADP aggregation showed moderate predictive values for bleeding events. The delta-ADP-Test (Multiplate) showed the strongest prediction of bleeding (area under the curve: 0.69). Adding platelet function and TEG markers to a model of clinical bleeding risk factors improved the prediction for bleeding events.

Conclusion This study indicates that thrombogenicity might be affected immediately after M-TEER probably due to changes in flow conditions. In particular, platelet aggregation involving the ADP receptor pathway significantly correlated with postprocedural bleeding events. Whether these results could guide peri-interventional antithrombotic therapy and improve peri- and postprocedural outcome requires further investigation.

Keywords

mitral regurgitation - M-TEER - bleeding - thromboelastography - platelet function


Publication History

Received: 08 May 2024

Accepted: 25 August 2024

Article published online:
18 September 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Georg Thieme Verlag KG
Stuttgart · New York

 

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