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Differences of blood coagulation parameters and platelet counts in patients undergoing transcatheter aortic valve implantation with Edwards SAPIEN 3 or Corevalve Evolut R

Session Poster Session 7

Speaker Taiga Katayama

Congress : ESC Congress 2018

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Aortic Valve Stenosis
  • Session type : Poster Session
  • FP Number : P6316

Authors : T Katayama (Tokyo,JP), N Yokoyama (Tokyo,JP), Y Watanabe (Tokyo,JP), S Takahashi (Tokyo,JP), H Kawamura (Tokyo,JP), M Nakashima (Tokyo,JP), K Kawasugi (Tokyo,JP), K Kozuma (Tokyo,JP)

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Authors:
T. Katayama1 , N. Yokoyama1 , Y. Watanabe1 , S. Takahashi1 , H. Kawamura1 , M. Nakashima1 , K. Kawasugi1 , K. Kozuma1 , 1Teikyo University School of Medicine - Tokyo - Japan ,

Citation:
European Heart Journal ( 2018 ) 39 ( Supplement ), 1320

Background: Thrombocytopenia after transcatheter aortic valve implantation (TAVI) has been recognized. However, cause of thrombocytopenia post TAVI was not clear.

Purpose: The purpose of this study was to investigate the state and change of the blood coagulation and their influence on post TAVI related thrombocytopenia in patients undergoing TAVI with SAPIEN 3 (S3) or Evolut R (ER).

Methods: We enrolled 63 patients (age: 85±5, male:13) undergoing transfemoral TAVI with S3 (n=38) or ER (n=25) valves. Patients with baseline platelet counts less than 100 ×109/L were excluded in this study. Platelet counts were measured before and after TAVI and 1, 2, 3 and 7 days postoperatively. Coagulation parameters as prothrombin activation fragment 1+2 (F1+2) and thrombin-anti-thrombin complex (TAT) were also assessed. Post TAVI related thrombocytopenia was defined as a decline in platelet count of ≥50% at nadir.

Results: Baseline platelet count was not different between S3 (201×109/L; 183–234×109/L range) and ER (196×109/L; 158–219×109/L range).

All blood coagulation parameters significantly increased on immediately after TAVI, while platelet counts started to drop and reached a nadir at day 3. Then platelet count recovered by day 7.

The change in F1+2 and TAT after S3 implantation was significantly greater than it after ER (Fig). These parameters recovered by Day 7. Thrombocytopenia occurred post TAVI in 23.7% with S3 and in 4% with ER (P=0.074). Platelet count at day 7 after S3 implantation was significantly less than it after ER (138×109/L; 117–166×109/L range vs. 166×109/L; 151–219 ×109/L range, p=0.02).

Conclusion: State of coagulation activation after TAVI differed with S3 and ER. This result may be caused by the structural difference in 2 valves. Although Incidence of thrombocytopenia did not differ between 2 valves, recovery of platelet counts after TAVI was low in patients with S3. Thus, careful attention should be paid to high coagulation status for S3.

Figure 1


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