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Open AccessArticle

Impact of Antithrombotic Regimen and Platelet Inhibition Extent on Leaflet Thrombosis Detected by Cardiac MDCT after Transcatheter Aortic Valve Replacement

1
Université de Strasbourg, Pôle d’Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France
2
Université de Strasbourg, Département de Radiologie, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France
3
UMR INSERM 1260 Regenerative Nanomedicine, Université de Strasbourg, 67000 Strasbourg, France
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(4), 506; https://doi.org/10.3390/jcm8040506
Received: 16 March 2019 / Revised: 1 April 2019 / Accepted: 9 April 2019 / Published: 12 April 2019
(This article belongs to the Section Cardiology)
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Abstract

The impact of antithrombotic regimen and platelet inhibition extent on subclinical leaflet thrombosis (SLT) detected by cardiac multidetector computed tomography (MDCT) after transcatheter aortic valve replacement (TAVR) is not well established. Hypoattenuation affecting motion (HAM) has been proposed as a surrogate marker of SLT, and is characterized by hypoattenuated leaflet thickening (HALT) and concomitant reduction in leaflet motion (RELM). We sought to investigate (i) the prevalence of HAM and HALT after TAVR detected by MDCT, (ii) the predictors of SLT, (iii) the impact of oral anticoagulant (OAC) and platelet inhibition extent assessed by platelet reactivity index vasodilator stimulated phosphoprotein (PRI-VASP) and closure time adenosine diphosphate (CT-ADP) on SLT. Of 187 consecutive patients who underwent TAVR from 1 August 2017 to 31 March 2018, 90 of them had cardiac CT at relevant follow-up. Clinical, biological, echocardiographic, procedural characteristics and treatments were collected before, at discharge, and 1 year after TAVR. P2Y12 platelet inhibition extent and primary haemostasis disorders were investigated using platelet PRI-VASP and CT-ADP point-of-care assays. Eighty-five post-TAVR CTs out of 90 were ranked for clarity and assessed with sufficient diagnostic quality. HAM was evidenced in 13 patients (15.3%) and HALT in 30 patients (35%). Procedural characteristics, including aortic valve calcium score, annulus size, or procedural heparin regimens, were equivalent between groups. Likewise, no impact of P2Y12 inhibition (PRI-VASP) nor primary haemostasis disorders (CT-ADP) on SLT could be evidenced. No impact of SLT on valve deterioration evaluated by transthoracic echocardiography (TTE) and clinical events could be established at 12 months follow-up. By multivariate analysis, lack of oral anticoagulant therapy at discharge (HR 12.130 CI 95% (1.394–150.582); p = 0.028) and higher haemoglobin levels were evidenced as the sole independent predictors of SLT. In four patients with HAM, MDCT follow-up was obtained after initiation of OAC therapy and showed a complete regression of HAM. SLT was evidenced in a sizeable proportion of patients treated by TAVR and was mainly determined by the lack of oral anticoagulant therapy. Conversely, no impact of platelet inhibition extent on SLT could be evidenced. View Full-Text
Keywords: TAVR; subclinical leaflet thrombosis; heart valve thrombosis; multidetector computed tomography; anticoagulation therapy; platelet; stroke; aortic valve stenosis; valve dysfunction TAVR; subclinical leaflet thrombosis; heart valve thrombosis; multidetector computed tomography; anticoagulation therapy; platelet; stroke; aortic valve stenosis; valve dysfunction
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Jimenez, C.; Ohana, M.; Marchandot, B.; Kibler, M.; Carmona, A.; Peillex, M.; Heger, J.; Trimaille, A.; Matsushita, K.; Reydel, A.; Hess, S.; Jesel, L.; Ohlmann, P.; Morel, O. Impact of Antithrombotic Regimen and Platelet Inhibition Extent on Leaflet Thrombosis Detected by Cardiac MDCT after Transcatheter Aortic Valve Replacement. J. Clin. Med. 2019, 8, 506.

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