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Reduction in thrombogenic activity and thrombocytopenia after transcatheter aortic valve implantation — The ATTRACTIVE-TTAS study
INTRODUCTION: Bleeding complications after transcatheter aortic valve implantation (TAVI) is a major problem in clinical practice. However, there is few information on thrombogenicity after TAVI. The aim of this study was to establish a monitoring of total thrombogenicity in perioperative TAVI using...
Autores principales: | , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441766/ https://www.ncbi.nlm.nih.gov/pubmed/30976651 http://dx.doi.org/10.1016/j.ijcha.2019.100346 |
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author | Ishii, Masanobu Kaikita, Koichi Mitsuse, Tatsuro Nakanishi, Nobuhiro Oimatsu, Yu Yamashita, Takayoshi Nagamatsu, Suguru Tabata, Noriaki Fujisue, Koichiro Sueta, Daisuke Takashio, Seiji Arima, Yuichiro Sakamoto, Kenji Yamamoto, Eiichiro Tsujita, Kenichi |
author_facet | Ishii, Masanobu Kaikita, Koichi Mitsuse, Tatsuro Nakanishi, Nobuhiro Oimatsu, Yu Yamashita, Takayoshi Nagamatsu, Suguru Tabata, Noriaki Fujisue, Koichiro Sueta, Daisuke Takashio, Seiji Arima, Yuichiro Sakamoto, Kenji Yamamoto, Eiichiro Tsujita, Kenichi |
author_sort | Ishii, Masanobu |
collection | PubMed |
description | INTRODUCTION: Bleeding complications after transcatheter aortic valve implantation (TAVI) is a major problem in clinical practice. However, there is few information on thrombogenicity after TAVI. The aim of this study was to establish a monitoring of total thrombogenicity in perioperative TAVI using the Total Thrombus-formation Analysis System (T-TAS), a microchip-based flow chamber system for analysis of thrombus formation under flow condition. METHODS: Twenty-three patients with severe aortic stenosis who underwent TAVI between August 2017 and March 2018 at Kumamoto university hospital were enrolled. After exclusion, data of 21 patients were analyzed. Blood samples were obtained before, 2, 7, and 30 days after TAVI. Thrombogenicity were assessed by the T-TAS to compute the area under the curve (AUC) (AR(10)-AUC(30)) in the AR chip. We also measured platelet count, high-molecular-weight von Willebrand factor (HMW-vWF) multimers, and plasma thrombopoietin. Computational fluid dynamics (CFD) analysis was performed to calculate the wall shear stress (WSS). RESULTS: The AR(10)-AUC(30) levels and platelet counts were significantly lower at 2 days post-TAVI, and then increased gradually. HMW-vWF multimers, and plasma thrombopoietin, were significantly higher at 2 days post-TAVI, compared with before TAVI. CFD analysis showed that WSS of the aortic valve and posterior ascending aortic wall were significantly lower after TAVI than before-TAVI. Multivariate analysis identified max velocity measured by echocardiography, platelet count, and D-dimer as significant determinants of AR(10)-AUC(30), representing total thrombogenicity. CONCLUSIONS: Although HMW-vWF multimers improved earlier after TAVI, total thrombogenic activity evaluated by T-TAS remained relatively low followed by improvement in thrombogenic activity at 30 days after TAVI. Clinical Trial Registration: https://clinicaltrials.gov. Unique identifiers: NCT03248232. |
format | Online Article Text |
id | pubmed-6441766 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-64417662019-04-11 Reduction in thrombogenic activity and thrombocytopenia after transcatheter aortic valve implantation — The ATTRACTIVE-TTAS study Ishii, Masanobu Kaikita, Koichi Mitsuse, Tatsuro Nakanishi, Nobuhiro Oimatsu, Yu Yamashita, Takayoshi Nagamatsu, Suguru Tabata, Noriaki Fujisue, Koichiro Sueta, Daisuke Takashio, Seiji Arima, Yuichiro Sakamoto, Kenji Yamamoto, Eiichiro Tsujita, Kenichi Int J Cardiol Heart Vasc Original Paper INTRODUCTION: Bleeding complications after transcatheter aortic valve implantation (TAVI) is a major problem in clinical practice. However, there is few information on thrombogenicity after TAVI. The aim of this study was to establish a monitoring of total thrombogenicity in perioperative TAVI using the Total Thrombus-formation Analysis System (T-TAS), a microchip-based flow chamber system for analysis of thrombus formation under flow condition. METHODS: Twenty-three patients with severe aortic stenosis who underwent TAVI between August 2017 and March 2018 at Kumamoto university hospital were enrolled. After exclusion, data of 21 patients were analyzed. Blood samples were obtained before, 2, 7, and 30 days after TAVI. Thrombogenicity were assessed by the T-TAS to compute the area under the curve (AUC) (AR(10)-AUC(30)) in the AR chip. We also measured platelet count, high-molecular-weight von Willebrand factor (HMW-vWF) multimers, and plasma thrombopoietin. Computational fluid dynamics (CFD) analysis was performed to calculate the wall shear stress (WSS). RESULTS: The AR(10)-AUC(30) levels and platelet counts were significantly lower at 2 days post-TAVI, and then increased gradually. HMW-vWF multimers, and plasma thrombopoietin, were significantly higher at 2 days post-TAVI, compared with before TAVI. CFD analysis showed that WSS of the aortic valve and posterior ascending aortic wall were significantly lower after TAVI than before-TAVI. Multivariate analysis identified max velocity measured by echocardiography, platelet count, and D-dimer as significant determinants of AR(10)-AUC(30), representing total thrombogenicity. CONCLUSIONS: Although HMW-vWF multimers improved earlier after TAVI, total thrombogenic activity evaluated by T-TAS remained relatively low followed by improvement in thrombogenic activity at 30 days after TAVI. Clinical Trial Registration: https://clinicaltrials.gov. Unique identifiers: NCT03248232. Elsevier 2019-03-28 /pmc/articles/PMC6441766/ /pubmed/30976651 http://dx.doi.org/10.1016/j.ijcha.2019.100346 Text en © 2019 The Authors http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Original Paper Ishii, Masanobu Kaikita, Koichi Mitsuse, Tatsuro Nakanishi, Nobuhiro Oimatsu, Yu Yamashita, Takayoshi Nagamatsu, Suguru Tabata, Noriaki Fujisue, Koichiro Sueta, Daisuke Takashio, Seiji Arima, Yuichiro Sakamoto, Kenji Yamamoto, Eiichiro Tsujita, Kenichi Reduction in thrombogenic activity and thrombocytopenia after transcatheter aortic valve implantation — The ATTRACTIVE-TTAS study |
title | Reduction in thrombogenic activity and thrombocytopenia after transcatheter aortic valve implantation — The ATTRACTIVE-TTAS study |
title_full | Reduction in thrombogenic activity and thrombocytopenia after transcatheter aortic valve implantation — The ATTRACTIVE-TTAS study |
title_fullStr | Reduction in thrombogenic activity and thrombocytopenia after transcatheter aortic valve implantation — The ATTRACTIVE-TTAS study |
title_full_unstemmed | Reduction in thrombogenic activity and thrombocytopenia after transcatheter aortic valve implantation — The ATTRACTIVE-TTAS study |
title_short | Reduction in thrombogenic activity and thrombocytopenia after transcatheter aortic valve implantation — The ATTRACTIVE-TTAS study |
title_sort | reduction in thrombogenic activity and thrombocytopenia after transcatheter aortic valve implantation — the attractive-ttas study |
topic | Original Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6441766/ https://www.ncbi.nlm.nih.gov/pubmed/30976651 http://dx.doi.org/10.1016/j.ijcha.2019.100346 |
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