Hadjadj Sandra, Beaudoin Jonathan, Beaupré Frédéric, Gravel Caroline, Marsit Ons, Pouliot Sylvain, Arsenault Benoit J, Pibarot Philippe, Farjat-Pasos Julio, Nuche-Berenguer Jorge, M-Labbé Benoît, O'Connor Kim, Bernier Mathieu, Salaun Erwan, Rodés-Cabau Josep, Paradis Jean-Michel
Quebec Heart and Lung Institute, Laval University, Quebec, QC G1V 4G5, Canada.
J Clin Med. 2025 Jan 27;14(3):831. doi: 10.3390/jcm14030831.
The recommendations for antithrombotic therapy after transcatheter edge-to-edge mitral valve repair (TEER) are empirical, and the benefit of antiplatelet (APT) or anticoagulation therapy (ACT) remains undetermined. The study sought to investigate the degree and the timing of coagulation and platelet marker activation after TEER. This was a prospective study including 46 patients undergoing TEER. The markers of coagulation activation, namely prothrombin fragment 1 + 2 (F1 + 2) and thrombin-antithrombin III (TAT), and the markers of platelet activation, namely soluble P-Selectin and soluble CD-40 ligand (sCD40L), were measured at baseline, 24 h, 1 month, and 1 year after TEER. At discharge, 20 (43%) patients received APT (single: 16, dual: 4), 24 (52%) received ACT, and 2 (4%) had both single APT and ACT. Levels of F1 + 2 and TAT significantly increased at 24 h post TEER (both < 0.001), rapidly returning to baseline levels at 1 month. However, levels of F1 + 2 and TAT remained higher at 1 month in patients without ACT compared to patients with ACT (respectively, 303.1 vs. 148.1 pmol/L; < 0.001 and 4.6 vs. 3.0 µg/L; = 0.020), with a similar trend at 1 year. Levels of soluble P-selectin and sCD40L remained stable at all times after TEER (respectively, = 0.071 and = 0.056), regardless of the APT. TEER is associated with an acute activation of the coagulation system, with no increase in platelet activation markers. Hence, the use of dual APT is questionable in this population. Our results raise the hypothesis that the optimal antithrombotic therapy after TEER could be short-term ACT over APT. Further larger studies are warranted.
经导管二尖瓣缘对缘修复术（TEER）后抗血栓治疗的建议是基于经验的，抗血小板治疗（APT）或抗凝治疗（ACT）的益处仍未确定。该研究旨在调查TEER后凝血和血小板标志物激活的程度及时间。这是一项前瞻性研究，纳入了46例行TEER的患者。在TEER术前、术后24小时、1个月和1年时，测定凝血激活标志物，即凝血酶原片段1+2（F1+2）和凝血酶-抗凝血酶III（TAT），以及血小板激活标志物，即可溶性P-选择素和可溶性CD-40配体（sCD40L）。出院时，20例（43%）患者接受APT（单一用药：16例，联合用药：4例），24例（52%）接受ACT，2例（4%）同时接受单一APT和ACT。TEER术后24小时，F1+2和TAT水平显著升高（均P<0.001），1个月时迅速恢复至基线水平。然而，与接受ACT的患者相比，未接受ACT的患者在1个月时F1+2和TAT水平仍较高（分别为303.1 vs. 148.1 pmol/L；P<0.001和4.6 vs. 3.0 μg/L；P=0.020），1年时也有类似趋势。TEER术后，可溶性P-选择素和sCD40L水平在所有时间均保持稳定（分别为P=0.071和P=0.056），与APT无关。TEER与凝血系统的急性激活有关，血小板激活标志物无增加。因此，在该人群中使用双重APT存在疑问。我们的结果提出了一个假设，即TEER术后最佳的抗血栓治疗可能是短期ACT而非APT。需要进一步开展更大规模的研究。
