Rotational Thromboelastometry in High-Risk Patients on Dual Antithrombotic Therapy After Percutaneous Coronary Intervention

Anne-Marije Hulshof*, Renske H Olie, Minka J A Vries, Paul W M Verhezen, Paola E J van der Meijden, Hugo Ten Cate, Yvonne M C Henskens

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

Aims: Patients using antithrombotic drugs after percutaneous coronary intervention (PCI) are at risk for bleeding and recurrent ischemia. We aimed to explore routine and tissue plasminogen activated (tPA) ROTEM results in a post-PCI population on dual antithrombotic treatment. Methods and Results: In this prospective cohort, 440 patients treated with double antithrombotic therapy after recent PCI and with ≥3 risk factors for either ischemic or bleeding complications were included and compared with a control group (n = 95) consisting of perioperative patients not using antithrombotic medication. Laboratory assessment, including (tPA) ROTEM, was performed one month post-PCI and bleeding/ischemic complications were collected over a five-month follow-up. Patients were stratified by antithrombotic regimen consisting of a P2Y12 inhibitor with either aspirin (dual antiplatelet therapy; DAPT, n = 323), a vitamin K antagonist (VKA, n = 69) or a direct oral anticoagulant (DOAC, n = 48). All post-PCI patients had elevated ROTEM clot stiffness values, but only the DAPT group additionally presented with a decreased fibrinolytic potential as measured with tPA ROTEM. Patients receiving anticoagulants had prolonged clotting times (CT) when compared to the control and DAPT group; EXTEM and FIBTEM CT could best discriminate between patients (not) using anticoagulants (AUC > 0.97). Furthermore, EXTEM CT was significantly prolonged in DAPT patients with bleeding complications during follow-up (68 [62-70] vs. 62 [57-68], p = 0.030). Conclusion: ROTEM CT has high potential for identifying anticoagulants and tPA ROTEM could detect a diminished fibrinolytic potential in patients using DAPT. Furthermore, the ability of EXTEM CT to identify patients at risk for bleeding may be promising and warrants further research.

Original languageEnglish
Article number788137
Number of pages11
JournalFrontiers in cardiovascular medicine
Volume8
DOIs
Publication statusPublished - 22 Dec 2021

Keywords

  • percutaneous coronary intervention
  • thromboelastometry (ROTEM (R))
  • fibrinolysis
  • anticoagulants
  • antiplatelet drug
  • DIRECT ORAL ANTICOAGULANTS
  • FIBRIN CLOT PROPERTIES
  • MYOCARDIAL-INFARCTION
  • EUROPEAN-SOCIETY
  • ARTERY-DISEASE
  • GUIDELINES
  • MANAGEMENT
  • THROMBIN
  • ASSOCIATION
  • CLOPIDOGREL

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