title: High on-treatment platelet reactivity in transcatheter aortic valve implantation patients.
abstract: Dual antiplatelet therapy (DAPT) is recommended early after transcatheter aortic valve implantation (TAVI) procedure at the moment despite the lack of evidence. Two small randomized trials failed to demonstrate DAPT to be superior to aspirin alone in TAVI patients. However, it is known that there are substantial response variabilities to antiplatelet medication. We aimed to investigate high on-treatment platelet reactivity (HTPR), low on-treatment platelet reactivity (LTPR) to clopidogrel as well as HTPR to aspirin in patients undergoing TAVI procedure. We analyzed data of 140 TAVI patients in a real world observational study. Platelet function assays (clopidogrel-vasodilator-stimulated protein phosphorylation assay; aspirin-light-transmission aggregometry) have been performed during hospital course. Clinical complications were investigated during 30 days follow-up and defined using the valve academic research consortium standardized criteria. HTPR to clopidogrel occurred in 87 (62%) patients and LTPR in 9 (6.4%) patients. Aspirin antiplatelet effects were insufficient in 25 (18%) patients. Clinical complications were observed in 35 (25%) patients. Ischemic events occurred in 6 (4%), bleeding complications in 28 (20%) patients. There were no differences regarding the incidence of HTPR/LTPR in patients with overall complications, ischemic events or bleeding events. HTPR to clopidogrel is very frequent in TAVI patients. However bleeding complications are frequent and ischemic events are rare. Therefore, future clinical trials investigating the optimal antithrombotic regiment in TAVI patients should consider this high incidence of HTPR to clopidogrel and monitor clopidogrel antiplatelet effects carefully.
authors: Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Düsseldorf, Düsseldorf, Germany. Electronic address: Amin.polzin@med.uni-duesseldorf.de.
authors: Amin
authors: A
authors: Polzin
authors: Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Düsseldorf, Düsseldorf, Germany.
authors: Mathias
authors: M
authors: Schleicher
authors: Department of Experimental and Clinical Hemostasis, Hemotherapy, and Transfusion Medicine, Heinrich Heine University Medical Center Düsseldorf, Düsseldorf, Germany.
authors: Holger
authors: H
authors: Seidel
authors: Department of Experimental and Clinical Hemostasis, Hemotherapy, and Transfusion Medicine, Heinrich Heine University Medical Center Düsseldorf, Düsseldorf, Germany.
authors: Rüdiger E
authors: RE
authors: Scharf
authors: Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Düsseldorf, Düsseldorf, Germany.
authors: Marc W
authors: MW
authors: Merx
authors: Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Düsseldorf, Düsseldorf, Germany.
authors: Malte
authors: M
authors: Kelm
authors: Division of Cardiology, Pulmonology, and Vascular Medicine, Heinrich Heine University Medical Center Düsseldorf, Düsseldorf, Germany.
authors: Tobias
authors: T
authors: Zeus
mesh_terms: D000368:Aged; D001241:Aspirin / Q000009:adverse effects / Q000494:pharmacology; D001792:Blood Platelets / Q000187:drug effects / Q000502:physiology*; D000077144:Clopidogrel; D005260:Female; D006801:Humans; D007511:Ischemia / Q000209:etiology / Q000503:physiopathology; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000494:pharmacology; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000494:pharmacology; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects*
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Aspirin - ACETYLSALICYLIC ACID (PubChem CID: 2244); Clopidogrel (PubChem CID: 60606); HTPR; TAVI