Department of Cardiology, Teikyo University School of Medicine, Tokyo, Japan.
Catheter Cardiovasc Interv. 2024 Nov;104(6):1281-1289. doi: 10.1002/ccd.31199. Epub 2024 Aug 21.
Transcatheter aortic valve implantation (TAVI) leads to transient platelet activation and hypercoagulation status, resulting in thrombocytopenia.
This study investigated the associations of coagulation/fibrinolysis status after transfemoral TAVI with valve type, post-TAVI thrombocytopenia, and complication of TAVI.
Thrombin-antithrombin complex (TAT) and fibrin/fibrinogen degradation product (FDP) levels were measured before and 1 h, 1 day, and 2 days after TAVI. A percentage drop in platelet count (DPC) was determined from the pre- and lowest post-procedural values.
SAPIEN 3 (S3) was implanted in 158 patients and Evolut PRO/PRO+ (Evolut) in 117. Both TAT and FDP increased after TAVI. Pre-TAVI balloon dilatation was generally performed on patients undergoing implantation with Evolut. Peak TAT was then stratified into 4 quartiles (Q1 to Q4). Of all 275 study patients, 69 patients reached ultra-hypercoagulation status (Q4). S3, TAVI without pre-balloon dilatation, DPC and bleeding complications were significantly associated with the ultra-hypercoagulation status after TAVI. TAT was significantly greater 1 h after S3 implantation than Evolut (median [IQR], 43.1 [34.1-59.6] vs. 31.0 [25.0-40.4] ng/mL; p < 0.001). In contrast, FDP levels did not differ between the two at any measurement point. The difference in DPC among the peak TAT quartiles was statistically significant (p < 0.001). The occurrence of bleeding complications was significantly higher in the group with ultra-hypercoagulation status (5.8% vs. 1.0%, p = 0.036).
The increase in coagulation status and post-TAVI thrombocytopenia were significantly greater after S3 implantation. Ultra-hypercoagulation after TAVI was related to bleeding complications.
经导管主动脉瓣植入术（TAVI）可导致短暂的血小板活化和高凝状态，从而引起血小板减少症。
本研究旨在探讨经股 TAVI 术后凝血/纤溶状态与瓣膜类型、TAVI 后血小板减少症及 TAVI 并发症的相关性。
在 TAVI 前、术后 1 小时、1 天和 2 天测量凝血酶-抗凝血酶复合物（TAT）和纤维蛋白/纤维蛋白原降解产物（FDP）水平。从术前和最低术后值中确定血小板计数的下降百分比（DPC）。
158 例患者植入 SAPIEN 3（S3）瓣膜，117 例患者植入 Evolut PRO/PRO+（Evolut）瓣膜。TAVI 后 TAT 和 FDP 均升高。行 Evolut 瓣膜植入术的患者通常行术前球囊扩张。随后将 TAT 峰值分为 4 个四分位（Q1 至 Q4）。在所有 275 例研究患者中，69 例达到超高凝状态（Q4）。S3、未行术前球囊扩张的 TAVI、DPC 和出血并发症与 TAVI 后超高凝状态显著相关。S3 植入后 1 小时 TAT 明显大于 Evolut（中位数[四分位数范围]，43.1[34.1-59.6] vs. 31.0[25.0-40.4]ng/mL；p<0.001）。相反，在任何测量点 FDP 水平在两种瓣膜之间均无差异。TAT 四分位中 DPC 的差异具有统计学意义（p<0.001）。超高凝状态组出血并发症的发生率明显更高（5.8% vs. 1.0%，p=0.036）。
S3 植入后凝血状态和 TAVI 后血小板减少症增加更明显。TAVI 后超高凝状态与出血并发症有关。
