Evaluation of latest viscoelastic coagulation assays in the transcatheter aortic valve implantation setting

Fanning, Jonathon P.; Roberts, Shaun; Merza, Megan; Anstey, Chris; Poon, K.; Incani, A.; Natani, Sarvesh

doi:10.1136/openhrt-2020-001565

Cited by 6 publications

(7 citation statements)

References 13 publications

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“…Finally, concerning maximum clot strength MA HKH , previous studies have shown that the MA HKH value transiently increases immediately after TAVI and normalises 6 hours postoperatively. 8 The present results show that MA HKH decreases from POD 1 to POD 3, indicating an antithrombotic change that may have resulted from a stronger effect of decreased platelet function than increased coagulation capacity after TAVI. These results may suggest that patients are more at risk for bleeding than for thromboembolism in the immediate post-TAVI period.…”

Section: Discussionmentioning

confidence: 48%

“…Only a few studies have examined changes in coagulation and platelet function using TEG after TAVI. Although previous studies using TEG 6s have reported intraprocedural thrombophilic tendency after valve implantation in TAVI, 8 there have been no studies after postoperative day (POD) 1. In addition, the trend of platelet function has not yet been adequately studied, particularly with TEG 6s.…”

Section: Introductionmentioning

confidence: 99%

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Changes in platelet function and coagulation after transcatheter aortic valve implantation evaluated with thromboelastography

et al. 2022

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IntroductionThe possibility of hypercoagulability during the perioperative period of transcatheter aortic valve implantation (TAVI) has been noted; however, there is still a controversy regarding the appropriate perioperative antithrombotic therapy. The study investigated coagulation and platelet functions during the TAVI perioperative period using thromboelastography (TEG) 6s platelet mapping.MethodsA prospective observational study was conducted on 25 patients undergoing TAVI. TEG platelet mapping was performed at three time points: on admission to the operating room (before heparinisation), on postoperative day (POD) 1 and on POD 3. Perioperative changes observed included: maximum clot strength (MAHKH), clot strength without platelet function (MAActF), time to initiation of clots formation by coagulation factors (RHKH) and platelet function (Gp). Gpis activated by thrombin, and not affected by antiplatelet agents. It is calculated as [(5000×MAHKH)/(100 – MAHKH)] − [(5000×MAActF)/(100 – MAActF)]. Finally, MAADP/AAand GADP/AA, which reflect clot strength and platelet aggregation mediated by ADP/thromboxane A2receptors, respectively, were also examined using the same method as for Gp.ResultsMAHKHcontinued to decrease until POD 3, indicating antithrombotic change after TAVI. Gpcontinuously decreased for 3 days after TAVI, while MAActFincreased significantly on POD 3. Furthermore, RHKHshortened on POD 1 and POD 3, suggesting increased coagulation capacity after TAVI. Finally, GADPin clopidogrel-naive patients was reduced for 3 days after TAVI, while GAAin aspirin-naive patients showed no significant change perioperatively.ConclusionsIn this study involving TEG platelet mapping, coagulation capacity increased while platelet function decreased, resulting in antithrombotic change for 3 days after TAVI. The ADP receptor system may be implicated in the decreased platelet function. These results may be useful for considering optimal perioperative antithrombotic therapy in TAVI.

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Section: Discussionmentioning

confidence: 48%

Section: Introductionmentioning

confidence: 99%

Changes in platelet function and coagulation after transcatheter aortic valve implantation evaluated with thromboelastography

et al. 2022

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“…TEG measures the speed and strength of coagulation, and provides a rapid global assessment of hemostatic function, including the parameters R (time until clot formation starts), K (rate of clot formation), and MA (maximum clot strength) 16 . The TEG 6s PlateletMapping cartridge has four channels: kaolin/heparinase (HKH), reptilase/factor XIIIa/abciximab (ActF), ADP/ActF (ADP) and arachidonic acid/ActF (AA) 17 . Seven parameters were measured: R‐HKH, K‐HKH, and MA‐HKH, which are the R, K, and MA values measured using HKH; MA‐ActF, the MA value measured using ActF; MA‐HKH minus MA‐ActF, the difference between MA values measured using HKH and ActF; and Aggregation‐ADP and MA‐ADP, the aggregation rate and MA measured using ADP.…”

Section: Methodsmentioning

confidence: 99%

“…16 The TEG 6s PlateletMapping cartridge has four channels: kaolin/heparinase (HKH), reptilase/factor XIIIa/abciximab (ActF), ADP/ActF (ADP) and arachidonic acid/ActF (AA). 17 Seven parameters were measured: R-HKH, K-HKH, and MA-HKH, which are the R, K, and MA values measured using HKH; MA-ActF, the MA value measured using ActF; MA-HKH minus MA-ActF, the difference between MA values measured using HKH and ActF; and Aggregation-ADP and MA-ADP, the aggregation rate and MA measured using ADP.…”

Section: Tegmentioning

confidence: 99%

Platelet function of whole blood after short‐term cold storage: A prospective in vitro observational study

et al. 2022

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Background There is no standardized storage temperature of whole blood for acute normovolemic hemodilution (ANH). Study Design and Methods We conducted a prospective observational study to examine the difference in platelet function between short‐term whole blood storage at 4 and 22°C. Venous blood (40 ml) was collected from seven healthy subjects who gave prior written consent. The samples were divided into three groups: before storage (group Pre), cold (4°C) storage (group C), and room temperature (22°C) storage (group R). Groups C and R were tested after 6 h of blood storage. Platelet aggregability, platelet factor 4 (PF4), β‐thromboglobulin (β‐TG), P‐selectin expression, pH, PO2, PCO2, glucose, lactate, blood count, and thromboelastography (TEG) parameters were measured. The percentage change in each parameter in groups C and R was calculated using the value in group Pre as a reference. These data were then compared between groups C and R using a Wilcoxon matched pairs test. p < 0.05 was considered to be statistically significant. Results Compared with group R, group C showed significantly higher platelet aggregability with adenosine diphosphate (ADP) 2, 4, and 6 μM (all p = 0.016) and collagen 1 μg/ml (p = 0.047) stimulation, and significantly lower PF4 and β‐TG elevation (both p = 0.031), glucose consumption (p = 0.031), and lactate production (p = 0.016). The ADP channel in TEG showed a significant increase in platelet aggregation rate in group C compared to group R. Discussion Cold storage of whole blood in ANH may provide improved storage conditions for platelets and contribute to improved hemostasis compared to room temperature storage.

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“… 75 76 A similar study of patients in China, using the TEG PlateletMapping Assay to stratify presurgical timing for patients on DAPT, also showed a reduced waiting time to 3.2 days prior to coronary artery bypass grafting, with no statistically significant difference in blood transfusions during surgery. 66 …”

Section: Left Atrial Appendage Closurementioning

confidence: 99%

Modified Thromboelastography for Peri-interventional Assessment of Platelet Function in Cardiology Patients: A Narrative Review

Hartmann

Curzen

2022

Semin Thromb Hemost

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Viscoelastic testing (VET), such as thromboelastography, can measure whole blood coagulation dynamics in real time and is used across a range of clinical settings, including cardiac surgery, liver transplant, and trauma. The use of modified thromboelastography with platelet function assessment (TEG(R) PlateletMapping(R) Assay) can provide an analysis of platelet contribution to hemostasis, including the contribution of the P2Y12 receptor and thromboxane pathway to platelet function. The TEG PlateletMapping Assay has shown high correlation with the current gold standard test of platelet function, light transmission aggregometry, to measure arachidonic acid and adenosine diphosphate agonist-induced platelet activation. Studies have also shown comparable results with other whole blood platelet function tests. In this review, we explore the clinical applications of modified thromboelastography with platelet function assessment. This includes guiding dual antiplatelet therapy in relation to cardiac procedures, such as percutaneous coronary interventions, transcatheter aortic valve replacement, and left atrial appendage closure. We also explore the developing use of thromboelastography in the emergency care setting of coronavirus disease 2019, which is commonly associated with a hypercoagulable and hypofibrinolytic state. Despite a general lack of high-quality, grade 1 evidence regarding the use of modified thromboelastography with platelet function assessment in these disease areas, the ability of the TEG PlateletMapping Assay to measure global hemostasis and platelet reactivity rapidly and to view and evaluate results at the point of care makes it a promising area for further study for managing patient treatment and optimizing hemostatic therapy.

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Evaluation of latest viscoelastic coagulation assays in the transcatheter aortic valve implantation setting

Cited by 6 publications

References 13 publications

Changes in platelet function and coagulation after transcatheter aortic valve implantation evaluated with thromboelastography

Changes in platelet function and coagulation after transcatheter aortic valve implantation evaluated with thromboelastography

Platelet function of whole blood after short‐term cold storage: A prospective in vitro observational study

Modified Thromboelastography for Peri-interventional Assessment of Platelet Function in Cardiology Patients: A Narrative Review

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