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Platelets and tavr

Marion Kibler, Benjamin Marchandot, Nathan Messas, Thibault Caspar, Flavien Vincent, Jean-Jacques Von Hunolstein, Lelia Grunebaum, Antje Reydel, Antoine Rauch, Ulun Crimizade, Michel Kindo, Tam Hoang Minh, Annie Trinh, Hélène Petit-Eisenmann, Fabien De Poli, Pierre Leddet, Laurence Jesel, Patrick Ohlmann, Sophie Susen, Eric Van Belle, Olivier Morel
BACKGROUND:  Paravalvular aortic regurgitation (PVAR) remains a frequent postprocedural concern following transcatheter aortic valve replacement (TAVR). Persistence of flow turbulence results in the cleavage of high-molecular-weight von Willebrand multimers, primary haemostasis dysfunction and may favour bleedings. Recent data have emphasized the value of a point-of-care measure of von Willebrand factor-dependent platelet function (closure time [CT] adenosine diphosphate [ADP]) in the monitoring of immediate PVAR...
March 28, 2018: Thrombosis and Haemostasis
Hitesh Raheja, Aakash Garg, Sunny Goel, Kinjal Banerjee, Gerald Hollander, Jacob Shani, Stephanie Mick, Jonathan White, Amar Krishnaswamy, Samir Kapadia
OBJECTIVE: We aim to evaluate the efficacy of dual versus single anti-platelet therapy (SAPT) after TAVR through a systematic review and meta-analysis of published research. BACKGROUND: Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is a commonly practiced strategy after transcatheter aortic valve replacement (TAVR). However, there is lack of sufficient evidence supporting this approach. METHOD: We searched PubMed, EMBASE, the Cochrane Central Register of Controlled trials, and the clinical trial registry maintained at clinicaltrials...
March 8, 2018: Catheterization and Cardiovascular Interventions
Qifeng Zhu, Xianbao Liu, Wei He, Yuxin He, Mengyao Tang, Yinghao Sun, Xiaobin Xu, Keda Shi, Huijia Kong, Jubo Jiang, Liangwei Chen, Jie Chen, Po Hu, Qiyuan Xu, Jianan Wang
OBJECTIVES: The importance of thrombocytopenia (TP) has been discussed previously. However, data are still limited, especially on predictors of TP. We sought to investigate predictors of TP after transcatheter aortic valve replacement (TAVR), in particular, clinically significant TP. METHODS: We reviewed a total of 123 consecutive patients undergoing TAVR in our medical center. They were stratified into 3 groups according to the nadir platelet count post-TAVR: no/mild TP, moderate TP, and severe TP...
2018: Cardiology
Florian Uhle, Christian Castrup, Anna-Maria Necaev, Philippe Grieshaber, Christoph Lichtenstern, Markus Alexander Weigand, Andreas Böning
Symptomatic aortic stenosis can be treated by surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR), the latter of which is regarded as a minimally invasive procedure. Differences between these procedures regarding immune responses or changes in coagulation and neurocognitive function have thus far been evaluated only sparsely. We carried out a prospective, single-center, nonrandomized explorative study with 38 patients. Thirteen patients were subjected to either SAVR or transfemoral (TF-) TAVR, and 12 patients underwent transapical (TA-) TAVR...
February 2018: Artificial Organs
Anna Sannino, Robert C Stoler, Robert F Hebeler, Molly Szerlip, Michael J Mack, Paul A Grayburn
AIMS: To investigate the influence of baseline thrombocytopenia (TCP) on short-term and long-term outcomes after transcatheter aortic valve replacement (TAVR). METHODS AND RESULTS: A total of 732 consecutive patients with severe, symptomatic aortic stenosis undergoing TAVR from January 2012 to December 2015 were included. Primary outcomes of interest were the relationship of baseline TCP with 30-day and 1-year all-cause mortality. Secondary outcomes of interest were procedural complications and in-hospital mortality in the same subgroups...
October 2017: Journal of Invasive Cardiology
Jose F Condado, Parichart Junpaparp, Jose N Binongo, Yi Lasanajak, Christian F Witzke-Sanz, Chandan Devireddy, Bradley Leshnower, Kreton Mavromatis, James Stewart, Robert Guyton, David Wheeler, Jessica Forcillo, Ateet Patel, Peter C Block, Vinod Thourani, Janani Rangaswami, Vasilis Babaliaros
BACKGROUND: Neutrophil-lymphocyte (NLR) and platelet-lymphocyte ratios (PLR) mark systemic inflammation. Patients with high NLR and PLR have worse cardiovascular disease and outcomes. We assessed the role of these ratios in predicting outcomes after transcatheter aortic valve replacement (TAVR). METHODS: The association between NLR and PLR with baseline characteristics, 30-day outcomes, and 1-year readmission/survival was determined in patients that underwent TAVR between 2007 and 2014 and had baseline complete blood count with differential...
November 15, 2016: International Journal of Cardiology
Firas E Zahr, Steven R Lentz
No abstract text is available yet for this article.
July 28, 2016: New England Journal of Medicine
Julio F Marchini, Ayumi Aurea Miyakawa, Flavio Tarasoutchi, José Eduardo Krieger, Pedro Lemos, Kevin Croce
BACKGROUND: Patients with severe aortic stenosis have increased levels of prothrombotic and proinflammatory microparticles (MP), and MPs actively regulate pathological processes that lead to atherothrombotic cardiovascular events. Shear stress is a validated stimulus of MP production, and abnormal shear stress in aortic stenosis increases MP release in ex-vivo studies. We hypothesized that in patients with severe aortic stenosis, percutaneous replacement of the aortic valve (TAVR) would reduce abnormal shear stress and would decrease levels of circulating MPs...
April 11, 2016: Journal of Negative Results in Biomedicine
Travis R Sexton, Eric L Wallace, Amy Chen, Richard J Charnigo, Hassan K Reda, Khaled M Ziada, John C Gurley, Susan S Smyth
Transcatheter aortic valve replacement (TAVR) has been increasingly used to treat patients with symptomatic aortic stenosis. Despite improvements in valve deployment, patients that have undergone TAVR are at high risk for major adverse events following the procedure. Blood cell numbers, platelet function, and biomarkers of systemic inflammation were analyzed in 58 patients undergoing TAVR with the Edward's SAPIEN valve. Following valve deployment, platelet count and agonist-induced platelet activity declined and plasma markers of systemic inflammation (interleukin-6 and S100A8/A9) increased...
April 2016: Journal of Thrombosis and Thrombolysis
Ioannis Mastoris, George D Dangas
While the main gist of research pertaining to TAVR procedure involves improvement of existing valve technologies, lower size delivery systems and post-procedure antithrombotic therapy, the optimal intra-procedure anticoagulation has not been sufficiently defined. Peri-procedural complications such as cerebrovascular events and bleeding are largely associated with the safety and efficacy of anticoagulation regimen. Current guidelines advocate the use of heparin for anticoagulation with a target activated clotting time ≥300 seconds and careful protamine infusion in patients with high estimated bleeding risk...
2016: Current Pharmaceutical Design
Suzanne Fateh-Moghadam, Sabrina Voesch, Patrik Htun, Rezo Jorbenadze, Tobias Geisler, Meinrad Gawaz, Wolfgang Bocksch
Stroke and thromboembolic events after transfemoral aortic valve replacement (TAVR) continue to be a problem. The aim of our study was to compare platelet aggregation (Agg) and platelet activation (PA) observed with two different catheter valves, the ESV-XT and the newer ESV-3 valve in patients (pts) undergoing TAVR on dual antiplatelet therapy (DAPT). A total of 174 patients with severe aortic stenosis and high surgical risk successfully underwent TAVR (60 ESV-XT; 114 ESV-3). Platelet Agg and PA (CD62P expression) were evaluated before and the following three days after TAVR under DAPT...
January 2016: Thrombosis and Haemostasis
Philippe Généreux, David J Cohen, Michael Mack, Josep Rodes-Cabau, Mayank Yadav, Ke Xu, Rupa Parvataneni, Rebecca Hahn, Susheel K Kodali, John G Webb, Martin B Leon
BACKGROUND: The incidence and prognostic impact of late bleeding complications after transcatheter aortic valve replacement (TAVR) are unknown. OBJECTIVES: The aim of this study was to identify the incidence, predictors, and prognostic impact of major late bleeding complications (MLBCs) (≥30 days) after TAVR. METHODS: Clinical and echocardiographic outcomes of patients who underwent TAVR within the randomized cohorts and continued access registries in the PARTNER (Placement of Aortic Transcatheter Valves) trial were analyzed after stratifying by the occurrence of MLBCs...
December 23, 2014: Journal of the American College of Cardiology
Peter C Block
No abstract text is available yet for this article.
January 1, 2015: Catheterization and Cardiovascular Interventions
Madan Raj Aryal, Paras Karmacharya, Anil Pandit, Fayaz Hakim, Ranjan Pathak, Naba Raj Mainali, Anene Ukaigwe, Maryam Mahmood, Madan Badal, F David Fortuin
BACKGROUND: Although dual antiplatelet therapy (DAPT) with clopidogrel and aspirin is a widely accepted strategy in patients undergoing transcatheter aortic valve replacement (TAVR), this approach is not evidence based. We therefore sought to systematically review the current evidence for this practice in terms of 30-day outcome looking at stroke, MI, bleeding, and death. METHODS: Relevant studies were identified through electronic literature search. Studies involving single antiplatelet therapy (SAPT) and DAPT in patients undergoing TAVR were included...
February 2015: Heart, Lung & Circulation
Michael P Flaherty, Amr Mohsen, Joseph B Moore, Carlo R Bartoli, Erik Schneibel, Wasiq Rawasia, Matthew L Williams, Kendra J Grubb, Glenn A Hirsch
BACKGROUND: Data are limited regarding transcatheter aortic valve replacement (TAVR)-related thrombocytopenia (TP). We sought to thoroughly characterize the presence, clinical impact, and severity of TP associated with TAVR. METHODS AND RESULTS: Data were collected from 90 patients who underwent TAVR using the Edwards SAPIEN valve (59 TF, 29 TA, 2 Tao). Platelet counts were evaluated peri-procedurally and for 8 days following TAVR. Platelet levels were compared and patients were divided into a no TP (No-TP) group 1, acquired (new) TP (NTP) group 2, pre-existing (pre-TAVR) TP (PTP) group 3, and further stratified based on the severity of TP: mild (M) TP (100-149 × 10(3) cell/µL) and moderate-severe (MS) TP (<100 × 10(3) cell/µL)...
January 1, 2015: Catheterization and Cardiovascular Interventions
Hasan Jilaihawi, Niraj Doctor, Tarun Chakravarty, Mohammad Kashif, James Mirocha, Wen Cheng, Michael Lill, Mamoo Nakamura, Mitch Gheorghiu, Raj R Makkar
OBJECTIVES: We sought to investigate the magnitude and clinical importance of thrombocytopenia post transcatheter aortic valve replacement (TAVR). BACKGROUND: Thrombocytopenia has been observed after TAVR but has not been well studied. METHODS: Major thrombocytopenia (platelet count <100 × 10(9) /L) was studied following aortic valve interventions in a single center. Changes in platelets were compared in 246 patients undergoing balloon-expandable TAVR and a similar population of 57 cases undergoing surgical aortic valve replacement (SAVR in the US PARTNER IA trial)...
January 1, 2015: Catheterization and Cardiovascular Interventions
Danny Dvir, Philippe Généreux, Israel M Barbash, Susheel Kodali, Itsik Ben-Dor, Mathew Williams, Rebecca Torguson, Ajay J Kirtane, Sa'ar Minha, Salem Badr, Lakshmana K Pendyala, Joshua P Loh, Petros G Okubagzi, Jessica N Fields, Ke Xu, Fang Chen, Rebecca T Hahn, Lowell F Satler, Craig Smith, Augusto D Pichard, Martin B Leon, Ron Waksman
AIMS: This study aimed to evaluate incidence and correlates for low platelet count after transcatheter aortic valve replacement (TAVR) and to determine a possible association between acquired thrombocytopenia and clinical outcomes. METHODS AND RESULTS: Patients undergoing TAVR from two medical centres were included in the study. They were stratified according to nadir platelet count post procedure: no/mild thrombocytopenia, ≥100 × 10(9)/L; moderate, 50-99 × 10(9)/L; and severe, <50 × 10(9)/L...
October 7, 2014: European Heart Journal
James M McCabe, Pei-Hsiu Huang, Lauren A Riedl, Srikanth R Devireddy, Jennifer Grondell, Annie C Connors, Michael J Davidson, Andrew C Eisenhauer, Frederick G P Welt
OBJECTIVES: To determine the incidence and etiology of thrombocytopenia following transcatheter Aortic valve replacement (TAVR). BACKGROUND: the use of TAVR in the United States has grown rapidly. Anecdotally, thrombocytopenia following TAVR with the Sapien valves has been observed, though little is known about this phenomenon. METHODS: All patients treated with TAVR using a Sapien valve or who underwent isolated balloon aortic valvuloplasty (BAV) at Brigham and Women's Hospital from October 2009 through November 2012 were analyzed...
March 1, 2014: Catheterization and Cardiovascular Interventions
Thomas E Claiborne, Jawaad Sheriff, Maximilian Kuetting, Ulrich Steinseifer, Marvin J Slepian, Danny Bluestein
Calcific aortic valve disease is the most common and life threatening form of valvular heart disease, characterized by stenosis and regurgitation, which is currently treated at the symptomatic end-stages via open-heart surgical replacement of the diseased valve with, typically, either a xenograft tissue valve or a pyrolytic carbon mechanical heart valve. These options offer the clinician a choice between structural valve deterioration and chronic anticoagulant therapy, respectively, effectively replacing one disease with another...
February 2013: Journal of Biomechanical Engineering
Melissa Fusari
OBJECTIVES: This paper reviews literary evidence on antithrombotic therapies currently employed in TAVR to assess validity and efficacy; duration and modality are also considered. In the absence of firm guidelines and reliable trial results, we analyze current knowledge of interaction between PPI and antithrombotic drugs. BACKGROUND: TAVR has been associated with Double Antiplatelet Therapy since 2002. This was an empirical approach for a new stentmounted tissue valve to prevent early and late MACCE that affect survival and quality of life...
2013: Current Pharmaceutical Design
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