Euper Miriam, Schreieck Jürgen, Bladt Mareike, Zdanyte Monika, Goldschmied Andreas, Sigle Manuel, Angiolillo Dominick J, Gorog Diana A, Jacobsen Mia Ravn, Sørensen Rikke, Rath Dominik, Gawaz Meinrad, Geisler Tobias
Department of Cardiology and Angiology, University Hospital Tübingen, Germany.
Division of Cardiology, University of Florida College of Medicine, Jacksonville, Florida, United States.
Thromb Haemost. 2025 Feb;125(2):130-141. doi: 10.1055/s-0044-1790604. Epub 2024 Sep 18.
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.
We sought to investigate the association of different parameters of platelet function and thrombogenicity with bleeding events post M-TEER.
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.
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.
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.
经导管二尖瓣修复术应用于有血栓形成和出血事件风险的患者群体。二尖瓣经导管缘对缘治疗（M-TEER）后对血小板功能和反应性的影响及其与出血事件的关联尚未得到系统研究。
我们试图研究M-TEER后血小板功能和血栓形成性的不同参数与出血事件的关联。
在这项单中心研究中，对100例连续接受TEER治疗的二尖瓣反流患者进行了分析。在放置装置前后，直接从左心房的引导导管中采集血液。使用阻抗聚集法（Multiplate）和TEG6s对血样进行分析。对手术前后的结果进行比较。主要结局是根据出血学术研究联盟分类在6个月内发生的任何出血并发症。
共有41例患者发生出血事件。TEG分析显示ADP聚集显著降低，ADP抑制增加。在ROC分析中，TEG ADP聚集和抑制以及Multiplate ADP聚集对出血事件显示出中等预测价值。δ-ADP试验（Multiplate）对出血的预测最强（曲线下面积：0.69）。将血小板功能和TEG标志物添加到临床出血危险因素模型中可改善对出血事件的预测。
本研究表明，M-TEER后血栓形成性可能立即受到影响，可能是由于血流状况的改变。特别是，涉及ADP受体途径的血小板聚集与术后出血事件显著相关。这些结果是否能指导围介入期抗栓治疗并改善围手术期和术后结局，需要进一步研究。
