Post-TAVR hypercoagulability (R-HKH ≤4.9 min, OR 1.12) and increased CRP, platelet count, and Protein S significantly predicted 6-month moderate-severe HALT (20% incidence).
Do hemostatic markers of hypercoagulability and inflammation predict moderate to severe HALT or RLM at 6 months in patients undergoing TAVR?
Hemostatic markers indicating hypercoagulability and inflammation during TAVR hospitalization can predict the occurrence of moderate to severe HALT or reduced leaflet motion at 6 months.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Patients after transcatheter aortic valve replacement (TAVR) have a high incidence of hypoattenuating leaflet thickening (HALT). However, data on hemostatic markers for predicting these outcomes are limited. Methods In a prospective single-center cohort study of patients undergoing TAVR from November 2020 to June 2022, hemostatic profiles were assessed during TAVR hospitalization. The profiling included thromboelastography (TEG), light transmission aggregometry (LTA), and conventional laboratory markers. The primary outcome was moderate to severe HALT grade 3 or 4 or reduced leaflet motion (RLM) Grade 2 or 3 detected by computed tomography angiography (CTA) at 6 months post-TAVR. Results Of the 107 patients included, 68 patients had interpretable CTA at 6 months. The primary outcome occurred in 14 patients (14/68=20%). Patients with HALT exhibited early signs of hypercoagulability and increased inflammation during their hospitalization following TAVR, as detected by TEG and conventional laboratory markers. Shortened clot formation time (R-HKH) measured during their hospitalization on TEG predicted HALT at 6 months (OR 1.12 1.00;1.25; p=0.05), with an optimal cut-off of 4.9 min (Sensitivity 79%, Specificity 74%, AUC 0.74 0.60;0.89, p=0.005). Increased platelet count (OR 1.08 1.01;1.15; p=0.03), elevated Protein S (OR 1.21 1.01;1.44; p=0.04), and higher C-reactive protein levels (OR: 1.19 1.00;1.41; p=0.05) significantly associated with HALT. Patients with HALT had no increase in major adverse cardiovascular events (MACE) or bleeding at six months. Conclusion Selected hemostatic markers indicating hypercoagulability and inflammation in post-TAVR patients, predicted moderate to severe HALT or RLM at 6 months, suggesting a more significant role of hemostasis and inflammation in HALT pathophysiology than previously reported.
Hesselbarth et al. (Sat,) reported a other. Post-TAVR hypercoagulability (R-HKH ≤4.9 min, OR 1.12) and increased CRP, platelet count, and Protein S significantly predicted 6-month moderate-severe HALT (20% incidence).