Dumonteil Nicolas, Levade Marie, Garcia Cédric, Lhermusier Thibault, Series Jennifer, Le Faouder Pauline, Marcheix Bertrand, Payrastre Bernard, Carrié Didier, Sié Pierre
Pôle Cardiovasculaire et Métabolique, Hôpital Rangueil, Toulouse, France.
INSERM, U1048 and Université Toulouse 3, Institut des Maladies Métaboliques et Cardiovasculaires, Toulouse, France.
TH Open. 2019 May 30;3(2):e146-e152. doi: 10.1055/s-0039-1692142. eCollection 2019 Apr.
Transcatheter aortic valve implantation (TAVI) is an established treatment option for symptomatic patients with severe aortic valve stenosis (AS). During and early after the procedure, both ischemic events (predominantly stroke) and bleedings remain prevalent. The optimal antithrombotic regimen is still debated. Single- versus dual-antiplatelet therapy is associated with a lower rate of severe bleeding, without difference in thrombotic complications. Although platelets have been empirically targeted, little is known on their contribution to these events primarily related to embolization of thrombotic material and tissue-derived debris from the wounded aortic valve and large vessels. The objective of this study was to assess local platelet activation in blood sampled in the ascending aorta immediately before and within minutes postimplantation. A series of 18 patients with AS on monotherapy with aspirin successfully underwent TAVI with the self-expandable Medtronic CoreValve by transfemoral route. No clinical thrombotic complication occurred at 30-day follow-up. Compared with patients with stable coronary artery disease unscathed of AS and similarly treated by low-dose aspirin, AS patients displayed a chronic state of platelet activation before TAVI, assessed in venous blood using various biomarkers. However, per procedure, in aortic blood, no change occurred between the two time points in the plasma levels of serotonin or 12-lipoxgenase products, or membrane exposure of granule markers CD62-P and CD63. Our results suggest that local acute platelet activation is limited during TAVI on monotherapy with aspirin.
经导管主动脉瓣植入术（TAVI）是有症状的严重主动脉瓣狭窄（AS）患者的既定治疗选择。在手术期间及术后早期，缺血事件（主要是中风）和出血仍然很常见。最佳抗栓方案仍存在争议。单药抗血小板治疗与双药抗血小板治疗相比，严重出血发生率较低，血栓形成并发症无差异。尽管一直以来都将血小板作为治疗靶点，但对于它们在这些主要与来自受损主动脉瓣和大血管的血栓物质及组织衍生碎片栓塞相关的事件中所起的作用知之甚少。本研究的目的是评估在植入前即刻及植入后数分钟内在升主动脉采集的血液中的局部血小板活化情况。一组18例接受阿司匹林单药治疗的AS患者通过经股动脉途径成功接受了使用可自膨胀美敦力CoreValve瓣膜进行的TAVI手术。30天随访时未发生临床血栓形成并发症。与未患AS且同样接受小剂量阿司匹林治疗的稳定型冠心病患者相比，AS患者在TAVI术前使用多种生物标志物在静脉血中评估显示出慢性血小板活化状态。然而，就每次手术而言，在主动脉血中，血清素或12 -脂氧合酶产物的血浆水平以及颗粒标志物CD62 - P和CD63的膜暴露在两个时间点之间均未发生变化。我们的结果表明在接受阿司匹林单药治疗的TAVI手术期间局部急性血小板活化受到限制。
