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Fibrin clot strength predicts major adverse cardiac events after transcatheter aortic valve replacement

https://doi.org/10.1007/s00392-025-02625-4

David Hesselbarth (Freiburg im Breisgau)1, M. D'Orazio (Freiburg im Breisgau)1, G. Ciccarone (Freiburg im Breisgau)1, D. Gjermeni (Freiburg im Breisgau)1, C. Jülch (Freiburg im Breisgau)1, J. Rilinger (Freiburg im Breisgau)1, T. Pottgießer (Kirchzarten)2, C. von zur Mühlen (Freiburg im Breisgau)3, D. Dürschmied (Mannheim)4, D. Westermann (Freiburg im Breisgau)5, C. Olivier (Freiburg im Breisgau)1

1Universitäts-Herzzentrum Freiburg - Bad Krozingen Klinik für Kardiologie und Angiologie Freiburg im Breisgau, Deutschland; 2Kardiologie Dreisamtal BAG Dr. Gabelmann /Prof. Dr. Pottgießer Kirchzarten, Deutschland; 3Albert- Ludwigs-Universität Freiburg Innere Medizin III, Kardiologie und Angiologie Freiburg im Breisgau, Deutschland; 4Universitätsklinikum Mannheim GmbH I. Medizinische Klinik Mannheim, Deutschland; 5Universitäts-Herzzentrum Freiburg - Bad Krozingen Innere Medizin III, Kardiologie und Angiologie Freiburg im Breisgau, Deutschland

 

Introduction:

Patients after transcatheter aortic valve replacement (TAVR) have a high incidence of cardiovascular events. However, routine use of anticoagulation in patients post-TAVR is not beneficial.

Methods:

In a prospective single-center study of patients undergoing TAVR from November 2020 to June 2022, individual hemostatic profiles were assessed during hospitalization using thromboelastography (TEG). Outcomes were evaluated at 6 months and included death, myocardial infarction, and stroke or TIA (MACE).

Results:

A total of 107 patients were included and 104 (97%) completed follow-up. Of these, 9 patients (9%) experienced MACE. Maximum platelet-fibrin clot stability (MA) was elevated in patients with MACE (per 1mm increase MA-CK: HR 1.26 [1.02;1.56], p= 0.03). Fibrin's role in MA was crucial, with elevated fibrinogen levels, increased fibrin clot strength (MA-CFF), and faster fibrin formation (alpha CRT), all associated with a higher risk of MACE (per 20 mg/dL fibrinogen increase: HR 1.15 [1.02–1.28], p=0.02; per 5 mm MA-CFF increase: HR 1.59 [1.12–2.26], p<0.01; per degree alpha-CRT increase: HR 1.55 [1.10–2.12], p=0.01, Figure 1). The optimal cut-off for MA-CFF in predicting MACE was determined to be 34.85 mm by ROC analysis. Kaplan-Meier analysis showed that patients with MA-CFF values above the cutoff of 34.85 mm had a significantly higher risk of MACE (HR 7.25 [1.80; 29.30], p < 0.01; Figure 2) 

Conclusion:

Functional hemostatic parameters, with functional fibrinogen as a key contributor, predicted MACE within 6 months in post-TAVR patients. Differentiating between platelet aggregation and fibrin coagulation could be a valuable focus for future trials to enhance personalized antithrombotic therapy.


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