Thrombin generation and clot lysis time to predict outcomes in patients undergoing transcatheter aortic valve implantation.

Abstract

Transcatheter aortic valve implantation (TAVI) is an established treatment method in patients with severe aortic stenosis at high surgical risk. TAVI might reduce thrombin generation and fibrin clot resistance to lysis. We aimed to evaluate the predictive value of thrombin generation and clot lysis time on TAVI outcomes. We screened 135 patients referred for TAVI. Thrombin generation (lag time, time to peak, peak thrombin concentration, and endogenous thrombin potential) and clot lysis time were assessed before TAVI and at hospital discharge. Major adverse cardiac and cerebrovascular events (MACCE) including all-cause death, cardiovascular death, myocardial infarction, stroke, transient ischemic attack, heart failure decompensation, and clinical valve thrombosis were assessed during 1-year follow-up. Among 70 patients who underwent TAVI, 14 (20%) experienced MACCE during the median follow-up of 361 days. Before TAVI, thrombin generation and clot lysis time were similar in patients with vs. without MACCE. Post-TAVI peak thrombin concentration was significantly lower in patients with MACCE (157.5 vs. 240.38 nM, p = 0.016), discriminated between those with and without MACCE (AUC: 0.773, p = 0.016), and was predictive for MACCE in both univariable (OR: 10.733, 95% CI: 1.197-96.283, p = 0.034) and multivariable (OR: 11.551, 95% CI: 1.104-120.828, p = 0.041) regression analyses. Pre-TAVI lag time was a predictor of MACCE in univariable regression analysis (OR: 5.304, 95% CI: 1.074-26.182, p = 0.041). Post-TAVI peak thrombin concentration and pre-TAVI lag time might potentially serve as novel predictors of MACCE in patients undergoing TAVI.