Platelet Reactivity and Early Outcomes after Transfemoral Aortic Valve Implantation

Lisa Gross; David Jochheim; Tobias Nitschke; Moritz Baquet; Martin Orban; Lesca Holdt; Magda Zadrozny; Christian Hagl; Daniel Teupser; Axel Bauer; Steffen Massberg; Julinda Mehilli; Dirk Sibbing

doi:10.1055/s-0038-1670658

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2018; 118(10): 1832-1838
DOI: 10.1055/s-0038-1670658

Atherosclerosis and Ischaemic Disease

Georg Thieme Verlag KG Stuttgart · New York

Platelet Reactivity and Early Outcomes after Transfemoral Aortic Valve Implantation

Lisa Gross

¹Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany

,

David Jochheim

¹Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany

²DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany

,

Tobias Nitschke

¹Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany

,

Moritz Baquet

¹Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany

,

Martin Orban

¹Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany

,

Lesca Holdt

³Department of Laboratory Medicine, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany

,

Magda Zadrozny

¹Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany

,

Christian Hagl

²DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany

⁴Department of Cardiac Surgery, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany

,

Daniel Teupser

³Department of Laboratory Medicine, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany

,

Axel Bauer

¹Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany

²DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany

,

Steffen Massberg

¹Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany

²DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany

,

Julinda Mehilli^*

¹Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany

²DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany

,

Dirk Sibbing^*

¹Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany

²DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany

› Author Affiliations

Abstract

Beyond thromboembolic events, peri-procedural bleeding remains one of the most frequent complications after transcatheter aortic valve implantation (TAVI). The majority of TAVI patients receive a dual anti-platelet treatment (DAPT) regimen. This analysis from the EVERY-TAVI register database aimed to analyse whether the level of on-treatment adenosine diphosphate-induced platelet reactivity predicts early outcomes at 30 days after TAVI. A total of 146 consecutive TAVI patients on DAPT who underwent platelet function testing with the Multiplate analyser were included here. Definition of bleeding events was done according to the Valve Academic Research Consortium-2 (VARC-2) classification. In our cohort, a status of low platelet reactivity (LPR, ≤ 18 units) was observed in 79 patients (54%), while high platelet reactivity (HPR, ≥ 46 units) was present in 18 patients (12%). At 30-day follow-up, the incidence of VARC-2 bleeds was 45.6% (n = 36) in LPR patients and 23.9% (n = 16) in patients without LPR (hazard ratio [HR] 2.10, 95% confidence interval [CI], 1.17–3.79; p = 0.01). In age-adjusted multivariate analysis, a status of LPR was independently associated with VARC-2 bleeding events (HR_adj, 2.06, 95% CI, 1.14–3.71; p = 0.02). HPR was not associated with the 30-day risk of death, stroke, or myocardial infarction (p ≥ 0.43). In summary, presence of LPR was associated with bleeding events in patients undergoing TAVI while presence of HPR was not associated with ischaemic outcomes at 30 days. The value of platelet function testing for bleeding risk prediction and for a possible guidance of anti-thrombotic treatment in the elderly TAVI population warrants further investigation.

Keywords

transcatheter aortic valve implantation - anti-platelet treatment - bleeding - platelet reactivity - ischaemia

Full Text

References

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