PMID- 31013785 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20201001 IS - 2077-0383 (Print) IS - 2077-0383 (Electronic) IS - 2077-0383 (Linking) VI - 8 IP - 4 DP - 2019 Apr 12 TI - Impact of Antithrombotic Regimen and Platelet Inhibition Extent on Leaflet Thrombosis Detected by Cardiac MDCT after Transcatheter Aortic Valve Replacement. LID - 10.3390/jcm8040506 [doi] LID - 506 AB - The impact of antithrombotic regimen and platelet inhibition extent on subclinical leaflet thrombosis (SLT) detected by cardiac multidetector computed tomography (MDCT) after transcatheter aortic valve replacement (TAVR) is not well established. Hypoattenuation affecting motion (HAM) has been proposed as a surrogate marker of SLT, and is characterized by hypoattenuated leaflet thickening (HALT) and concomitant reduction in leaflet motion (RELM). We sought to investigate (i) the prevalence of HAM and HALT after TAVR detected by MDCT, (ii) the predictors of SLT, (iii) the impact of oral anticoagulant (OAC) and platelet inhibition extent assessed by platelet reactivity index vasodilator stimulated phosphoprotein (PRI-VASP) and closure time adenosine diphosphate (CT-ADP) on SLT. Of 187 consecutive patients who underwent TAVR from 1 August 2017 to 31 March 2018, 90 of them had cardiac CT at relevant follow-up. Clinical, biological, echocardiographic, procedural characteristics and treatments were collected before, at discharge, and 1 year after TAVR. P2Y(12) platelet inhibition extent and primary haemostasis disorders were investigated using platelet PRI-VASP and CT-ADP point-of-care assays. Eighty-five post-TAVR CTs out of 90 were ranked for clarity and assessed with sufficient diagnostic quality. HAM was evidenced in 13 patients (15.3%) and HALT in 30 patients (35%). Procedural characteristics, including aortic valve calcium score, annulus size, or procedural heparin regimens, were equivalent between groups. Likewise, no impact of P2Y(12) inhibition (PRI-VASP) nor primary haemostasis disorders (CT-ADP) on SLT could be evidenced. No impact of SLT on valve deterioration evaluated by transthoracic echocardiography (TTE) and clinical events could be established at 12 months follow-up. By multivariate analysis, lack of oral anticoagulant therapy at discharge (HR 12.130 CI 95% (1.394-150.582); p = 0.028) and higher haemoglobin levels were evidenced as the sole independent predictors of SLT. In four patients with HAM, MDCT follow-up was obtained after initiation of OAC therapy and showed a complete regression of HAM. SLT was evidenced in a sizeable proportion of patients treated by TAVR and was mainly determined by the lack of oral anticoagulant therapy. Conversely, no impact of platelet inhibition extent on SLT could be evidenced. FAU - Jimenez, Charline AU - Jimenez C AUID- ORCID: 0000-0002-9435-0436 AD - Universite de Strasbourg, Pole d'Activite Medico-Chirurgicale Cardio-Vasculaire, Nouvel Hopital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France. charline.jimenez@chru-strasbourg.fr. FAU - Ohana, Mickael AU - Ohana M AUID- ORCID: 0000-0003-0179-5784 AD - Universite de Strasbourg, Departement de Radiologie, Nouvel Hopital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France. mickael.ohana@chru-strasbourg.fr. FAU - Marchandot, Benjamin AU - Marchandot B AD - Universite de Strasbourg, Pole d'Activite Medico-Chirurgicale Cardio-Vasculaire, Nouvel Hopital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France. benjamin.marchandot@chru-strasbourg.fr. FAU - Kibler, Marion AU - Kibler M AD - Universite de Strasbourg, Pole d'Activite Medico-Chirurgicale Cardio-Vasculaire, Nouvel Hopital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France. marion.kibler@chru-strasbourg.fr. FAU - Carmona, Adrien AU - Carmona A AD - Universite de Strasbourg, Pole d'Activite Medico-Chirurgicale Cardio-Vasculaire, Nouvel Hopital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France. adrien.carmona@chru-strasbourg.fr. FAU - Peillex, Marilou AU - Peillex M AD - Universite de Strasbourg, Pole d'Activite Medico-Chirurgicale Cardio-Vasculaire, Nouvel Hopital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France. marilou.peillex@chru-strasbourg.fr. FAU - Heger, Joe AU - Heger J AD - Universite de Strasbourg, Pole d'Activite Medico-Chirurgicale Cardio-Vasculaire, Nouvel Hopital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France. joe.heger@chru-strasbourg.fr. FAU - Trimaille, Antonin AU - Trimaille A AD - Universite de Strasbourg, Pole d'Activite Medico-Chirurgicale Cardio-Vasculaire, Nouvel Hopital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France. antonin.trimaille@chru-strasbourg.fr. FAU - Matsushita, Kensuke AU - Matsushita K AD - Universite de Strasbourg, Pole d'Activite Medico-Chirurgicale Cardio-Vasculaire, Nouvel Hopital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France. matsuken_22@yahoo.co.jp. FAU - Reydel, Antje AU - Reydel A AD - Universite de Strasbourg, Pole d'Activite Medico-Chirurgicale Cardio-Vasculaire, Nouvel Hopital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France. anne-claire.reydel@chru-strasbourg.fr. FAU - Hess, Sebastien AU - Hess S AD - Universite de Strasbourg, Pole d'Activite Medico-Chirurgicale Cardio-Vasculaire, Nouvel Hopital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France. sebastien.hess@chru-strasbourg.fr. FAU - Jesel, Laurence AU - Jesel L AD - Universite de Strasbourg, Pole d'Activite Medico-Chirurgicale Cardio-Vasculaire, Nouvel Hopital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France. Laurence.JESEL-MOREL@chru-strasbourg.fr. AD - UMR INSERM 1260 Regenerative Nanomedicine, Universite de Strasbourg, 67000 Strasbourg, France. Laurence.JESEL-MOREL@chru-strasbourg.fr. FAU - Ohlmann, Patrick AU - Ohlmann P AD - Universite de Strasbourg, Pole d'Activite Medico-Chirurgicale Cardio-Vasculaire, Nouvel Hopital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France. Patrick.Ohlmann@chru-strasbourg.fr. FAU - Morel, Olivier AU - Morel O AD - Universite de Strasbourg, Pole d'Activite Medico-Chirurgicale Cardio-Vasculaire, Nouvel Hopital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France. olivier.morel@chru-strasbourg.fr. AD - UMR INSERM 1260 Regenerative Nanomedicine, Universite de Strasbourg, 67000 Strasbourg, France. olivier.morel@chru-strasbourg.fr. LA - eng PT - Journal Article DEP - 20190412 PL - Switzerland TA - J Clin Med JT - Journal of clinical medicine JID - 101606588 PMC - PMC6518225 OTO - NOTNLM OT - TAVR OT - anticoagulation therapy OT - aortic valve stenosis OT - heart valve thrombosis OT - multidetector computed tomography OT - platelet OT - stroke OT - subclinical leaflet thrombosis OT - valve dysfunction COIS- The authors declare no conflicts of interest. EDAT- 2019/04/25 06:00 MHDA- 2019/04/25 06:01 PMCR- 2019/04/12 CRDT- 2019/04/25 06:00 PHST- 2019/03/16 00:00 [received] PHST- 2019/04/01 00:00 [revised] PHST- 2019/04/09 00:00 [accepted] PHST- 2019/04/25 06:00 [entrez] PHST- 2019/04/25 06:00 [pubmed] PHST- 2019/04/25 06:01 [medline] PHST- 2019/04/12 00:00 [pmc-release] AID - jcm8040506 [pii] AID - jcm-08-00506 [pii] AID - 10.3390/jcm8040506 [doi] PST - epublish SO - J Clin Med. 2019 Apr 12;8(4):506. doi: 10.3390/jcm8040506.