Abstract 14983: Platelet Drop After Implantation of the CoreValve Prothesis is Comparable to the Edwards Sapien Valve
Background: After CoreValve (CoV) implantation a significant platelet drop is observed which might be due to the large cage of the prosthesis and to platelet consumption. Patients (pts) are treated with aspirin (ASA) and clopidogrel (Clp) for 6 months to prevent procedural-related thrombocytopenia. One might speculate that the Edward Sapien valve (ES) due to its different shape does not show this procedure related thrombocytopenia.
Aim of the study: The aim of this study was to compare platelet drop, platelet aggregation (Plt Agg) and platelet activation (PA) between the ES valve and the CoV valve system.
Methods: Platelet function was assessed in consecutive 36 pts with symptomatic severe aortic stenosis who underwent TAVI in local anesthesia at our hospital. All pts were loaded with 600 mg Clp and 500 mg ASA the day before intervention. Plt Agg was evaluated by the Multiplate system (Dynabyte, Munich, Germany) before (T0) and directly after intervention (T1) and on day 1,2,3 and day 4. PA was assessed by flow cytometry (CD62P and PAC-1).
Results: We consecutively analyzed 18 CoV pts (age 80.4±1.4 years , log Euroscore 24.9±1.2, pmean 43.7±3.1 mmHg, aortic valve area (ava) 0.6 ± 0.4 cm2 , LVEF 55±1.7 % ) and 18 ES pts (age 81.5 ± 1.4 years, log Euroscore 19.2± 1.4, Pmean 44.0± 3.7 mmHg, ava 0.6 ± 0.03 cm2, LVEF 56.7± 1.9 %) .
Between T0 and day 3 we observed in both groups a decrease in platelet count (ES: 64.3 ± 5.8 versus CoV: 58.3 ± 8.9; P=0.232) which was statistically not significant.
There was no difference in ADP-, and TRAP-induced Plt Agg at T1 , T2 and T3 between the two valves.
[[Unable to Display Character: ]]Plt Agg of CoV pts at T1 (AGGADP 24.4 ± 3.5 , AGGTRAP 72.2 ± 7.5), at T2 (AGGADP 13.6± 3.0, AGGTRAP 42.2 ± 6.4 ) and at T3 ( AGGADP 12.9± 1.9, AGGTRAP 33.9 ± 5.4) versus Plt Agg of ES pts at T1( AGGADP 18.3 ± 2.9 , AGGTRAP 71.1 ± 4.7), T2 (AGGADP 10.7± 1.9, AGGTRAP 49.2 ± 4.3) and at T3 (AGGADP 12.3± 2.3, AGGTRAP 43.6 ± 4.5); p = n.s. [[Unable to Display Character: ]].
PA (CD62P, PAC-1 expression) was also not significantly different between ES and CoV (data not shown)-
Conclusion: Our study shows that TAVI-related transient thrombocytopenia is not related to the type of valve system (self - or balloon expandable) used.
- © 2013 by American Heart Association, Inc.