Hemostatic biomarkers and antithrombotic strategy in percutaneous left atrial interventions: State-of-the-art review

Errol W Aarnink, Marina F M Huijboom, Willem L Bor, Moniek Maarse, Kai L Zheng, Hugo Ten Cate, Jurriën M Ten Berg, Lucas V A Boersma

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

Atrial septal defect, persistent foramen ovale and the left atrial appendage are nowadays often percutaneously closed with implantable devices. These interventions may be complicated by thromboembolic events and the perfect post-procedural antithrombotic management is still under investigation. The mechanisms leading to left atrial device-related thrombus and thromboembolic complications are not fully understood. Biomarkers of coagulation activation are elevated following percutaneous device placement, peaking within one month and returning to baseline values after three months. By contrast, platelet reactivity shows no post-procedural increase. This suggests that an optimal antithrombotic regimen should perhaps include (oral) anticoagulation therapy rather than the currently more frequently prescribed antiplatelet-based regimen. Furthermore, biomarkers of endothelial activation, fibrinolysis, and on-treatment platelet reactivity may be of value in predicting device-related thrombus and bleeding and guide future medical strategy, facilitating personalized medicine.

Original languageEnglish
Pages (from-to)41-51
Number of pages11
JournalThrombosis Research
Volume215
DOIs
Publication statusPublished - Jul 2022

Keywords

  • Atrial Appendage/surgery
  • Atrial Fibrillation/complications
  • Biomarkers
  • Cardiac Catheterization/adverse effects
  • Fibrinolytic Agents/pharmacology
  • Foramen Ovale, Patent/complications
  • Heart Diseases/complications
  • Hemostatics
  • Humans
  • Retrospective Studies
  • Septal Occluder Device/adverse effects
  • Thromboembolism/drug therapy
  • Thrombosis/complications
  • Treatment Outcome

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