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. 2019;15(2):176-186.
doi: 10.5114/aic.2019.83649. Epub 2019 Mar 15.

Peri-procedural hemostasis disorders in surgical and transcatheter aortic valve implantation

Katarzyna Czerwińska-Jelonkiewicz  1 , Krzysztof Milewski  1 , Piotr Buszman  1 , Przemysław Kwasiborski  2 , Krzysztof Sanetra  3 , Wojciech Domaradzki  3 , Paweł Buszman  1
Affiliations

Peri-procedural hemostasis disorders in surgical and transcatheter aortic valve implantation

Katarzyna Czerwińska-Jelonkiewicz et al. Postepy Kardiol Interwencyjnej. 2019.

Abstract

Introduction: Despite their high effectiveness, surgical aortic valve replacement (AVR) and transcatheter aortic valve implantation (TAVI) are associated with substantial risk of bleeding. Although procedure-related hemostasis disorders might be crucial for safety of both procedures, the amount of data on the peri-procedural status of hemostasis in patients with aortic valve stenosis (AS) subjected to AVR and TAVI is negligible.

Aim: To investigate the profile of peri-procedural hemostasis in elderly patients with AS, subjected to aortic valve prosthesis implantation.

Material and methods: We performed a prospective analysis of global hemostasis using ROTEM thromboelastometry and platelet reactivity assessment using impedance aggregometry in 30 consecutive patients ≥ 70 years old subjected to AVR and TAVI. All tests were performed within 24 h before, directly and 24 h after the procedures.

Results: Surgical aortic valve replacement was characterized by transient hypofibrinogenemia and von Willebrand factor (vWF) depletion, which quickly recovered within 24 h after AVR. Transcatheter aortic valve implantation was characterized by substantial alteration of platelet function and vWF depletion with significant platelet reactivity impairment and increase in platelet sensitivity to antiplatelet agent, early after the procedure. TAVI-related hemostasis alterations were not recovered at 24 h after the procedure.

Conclusions: Surgical and transcatheter aortic valve replacement procedures are associated with substantial and diverse peri-procedural hemostasis disorders. Since hemostasis disorders related to TAVI are mainly characterized by impaired platelet function, early dual antiplatelet prophylaxis after TAVI requires careful consideration.

Keywords: aortic valve replacement; bleeding complications; peri-procedural hemostasis disorders; platelet reactivity; transcatheter aortic valve implantation.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Changes in thromboelastometry rexTEM test related to AVR vs. TAVI. Comparison of median values of CT, CFT, A5-A30, MCF, LI, ML between cohorts
Figure 2
Figure 2
Changes in thromboelastometry fibTEM test related to AVR vs. TAVI. Comparison of median values of CT, CFT, A5-A30, MCF, LI, ML between cohorts
Figure 3
Figure 3
Comparison of changes in platelet reactivity related to AVR vs. TAVI. A – COX-1 activity, B – P2Y12 receptor activity, C – PAR-1 receptor activity, D – vWF activity
Figure 4
Figure 4
Comparison of changes in platelet count related to AVR vs. TAVI
See this image and copyright information in PMC

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