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Evolution of Coagulation and Platelet Activation Markers after Transcatheter Edge-to-Edge Mitral Valve Repair

Sandra Hadjadj, Jonathan Beaudoin, Frédéric Beaupré,Caroline Gravel,Ons Marsit, Sylvain Pouliot, Benoit J Arsenault,Philippe Pibarot,Julio Farjat-Pasos, Jorge Nuche-Berenguer, Benoît M-Labbé,Kim O'Connor,Mathieu Bernier,Erwan Salaun,Josep Rodés-Cabau,Jean-Michel Paradis

Journal of clinical medicine(2025)

Quebec Heart and Lung Institute

Cited 0|Views2
Abstract
Background/Objectives: The recommendations for antithrombotic therapy after transcatheter edge-to-edge mitral valve repair (TEER) are empirical, and the benefit of antiplatelet (APT) or anticoagulation therapy (ACT) remains undetermined. The study sought to investigate the degree and the timing of coagulation and platelet marker activation after TEER. Methods: This was a prospective study including 46 patients undergoing TEER. The markers of coagulation activation, namely prothrombin fragment 1 + 2 (F1 + 2) and thrombin-antithrombin III (TAT), and the markers of platelet activation, namely soluble P-Selectin and soluble CD-40 ligand (sCD40L), were measured at baseline, 24 h, 1 month, and 1 year after TEER. Results: At discharge, 20 (43%) patients received APT (single: 16, dual: 4), 24 (52%) received ACT, and 2 (4%) had both single APT and ACT. Levels of F1 + 2 and TAT significantly increased at 24 h post TEER (both p < 0.001), rapidly returning to baseline levels at 1 month. However, levels of F1 + 2 and TAT remained higher at 1 month in patients without ACT compared to patients with ACT (respectively, 303.1 vs. 148.1 pmol/L; p < 0.001 and 4.6 vs. 3.0 µg/L; p = 0.020), with a similar trend at 1 year. Levels of soluble P-selectin and sCD40L remained stable at all times after TEER (respectively, p = 0.071 and p = 0.056), regardless of the APT. Conclusions: TEER is associated with an acute activation of the coagulation system, with no increase in platelet activation markers. Hence, the use of dual APT is questionable in this population. Our results raise the hypothesis that the optimal antithrombotic therapy after TEER could be short-term ACT over APT. Further larger studies are warranted.
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transcatheter mitral valve repair,coagulation,platelets,antithrombin III,P-selectin
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要点】:研究探讨了经导管边缘对边缘二尖瓣修复(TEER)后凝血和血小板激活标记物的变化,提出短期抗凝治疗可能优于抗血小板治疗。

方法】:采用前瞻性研究方法,对46例行TEER的患者在术前、术后24小时、1个月和1年分别检测凝血激活标记物(F1 + 2和TAT)和血小板激活标记物(可溶性P-选择素和sCD40L)。

实验】:患者在出院时,43%接受抗血小板治疗(单药:16,双药:4),52%接受抗凝治疗,4%同时接受单药抗血小板和抗凝治疗。F1 + 2和TAT在TEER后24小时显著升高,1个月后迅速恢复至基线水平,但在未接受抗凝治疗的患者中,F1 + 2和TAT在1个月时仍高于接受抗凝治疗的患者。可溶性P-选择素和sCD40L在TEER后各时间点保持稳定。