Dynamics of Thrombogenicity and Platelet Function and Correlation with Bleeding Risk in Patients Undergoing M-TEER Using the PASCAL System

Miriam Euper; Jürgen Schreieck; Mareike Bladt; Monika Zdanyte; Andreas Goldschmied; Manuel Sigle; Dominick J Angiolillo; Diana A Gorog; Mia Ravn Jacobsen; Rikke Sørensen; Dominik Rath; Meinrad Gawaz; Tobias Geisler

doi:10.1055/s-0044-1790604

Dynamics of Thrombogenicity and Platelet Function and Correlation with Bleeding Risk in Patients Undergoing M-TEER Using the PASCAL System

Miriam Euper^*, Jürgen Schreieck, Mareike Bladt, Monika Zdanyte, Andreas Goldschmied, Manuel Sigle, Dominick J Angiolillo, Diana A Gorog, Mia Ravn Jacobsen, Rikke Sørensen, Dominik Rath, Meinrad Gawaz, Tobias Geisler

^*Corresponding author for this work

Department of Cardiology

Abstract

BACKGROUND: Transcatheter mitral valve repair is performed in a patient population at risk for thrombotic and bleeding events. The effects on platelet function and reactivity and their association with bleeding events after mitral transcatheter edge-to-edge therapy (M-TEER) have not been systematically examined.

OBJECTIVES: We sought to investigate the association of different parameters of platelet function and thrombogenicity with bleeding events post M-TEER.

METHODS: In this single-center study, 100 consecutive patients with mitral regurgitation receiving TEER were analyzed. Blood was taken directly from the guide-catheter in the left atrium before and after placing the device. Blood samples were analyzed using impedance aggregometry (Multiplate) and TEG6s. The results were compared pre- and postprocedural. The primary outcome was any bleeding complication according to the Bleeding Academic Research Consortium classification within 6 months.

RESULTS: A total of 41 patients experienced bleeding events. TEG analysis showed a significant decrease in ADP aggregation and increase in ADP inhibition. In ROC-analysis, TEG ADP aggregation and inhibition and Multiplate ADP aggregation showed moderate predictive values for bleeding events. The delta-ADP-Test (Multiplate) showed the strongest prediction of bleeding (area under the curve: 0.69). Adding platelet function and TEG markers to a model of clinical bleeding risk factors improved the prediction for bleeding events.

CONCLUSION: This study indicates that thrombogenicity might be affected immediately after M-TEER probably due to changes in flow conditions. In particular, platelet aggregation involving the ADP receptor pathway significantly correlated with postprocedural bleeding events. Whether these results could guide peri-interventional antithrombotic therapy and improve peri- and postprocedural outcome requires further investigation.

Original language	English
Journal	Thrombosis and Haemostasis
Volume	125
Issue number	2
Pages (from-to)	130-141
Number of pages	12
ISSN	0340-6245
DOIs	https://doi.org/10.1055/s-0044-1790604
Publication status	Published - Feb 2025

Keywords

M-TEER
bleeding
mitral regurgitation
platelet function
thromboelastography

Access to Document

10.1055/s-0044-1790604

Cite this

Euper, M., Schreieck, J., Bladt, M., Zdanyte, M., Goldschmied, A., Sigle, M., Angiolillo, D. J., Gorog, D. A., Jacobsen, M. R., Sørensen, R., Rath, D., Gawaz, M., & Geisler, T. (2025). Dynamics of Thrombogenicity and Platelet Function and Correlation with Bleeding Risk in Patients Undergoing M-TEER Using the PASCAL System. Thrombosis and Haemostasis, 125(2), 130-141. https://doi.org/10.1055/s-0044-1790604

Euper, M, Schreieck, J, Bladt, M, Zdanyte, M, Goldschmied, A, Sigle, M, Angiolillo, DJ, Gorog, DA, Jacobsen, MR, Sørensen, R, Rath, D, Gawaz, M & Geisler, T 2025, 'Dynamics of Thrombogenicity and Platelet Function and Correlation with Bleeding Risk in Patients Undergoing M-TEER Using the PASCAL System', Thrombosis and Haemostasis, vol. 125, no. 2, pp. 130-141. https://doi.org/10.1055/s-0044-1790604

@article{b61c6e92a3c6409c9123fd096595da35,

title = "Dynamics of Thrombogenicity and Platelet Function and Correlation with Bleeding Risk in Patients Undergoing M-TEER Using the PASCAL System",

abstract = "BACKGROUND: Transcatheter mitral valve repair is performed in a patient population at risk for thrombotic and bleeding events. The effects on platelet function and reactivity and their association with bleeding events after mitral transcatheter edge-to-edge therapy (M-TEER) have not been systematically examined.OBJECTIVES: We sought to investigate the association of different parameters of platelet function and thrombogenicity with bleeding events post M-TEER.METHODS: In this single-center study, 100 consecutive patients with mitral regurgitation receiving TEER were analyzed. Blood was taken directly from the guide-catheter in the left atrium before and after placing the device. Blood samples were analyzed using impedance aggregometry (Multiplate) and TEG6s. The results were compared pre- and postprocedural. The primary outcome was any bleeding complication according to the Bleeding Academic Research Consortium classification within 6 months.RESULTS: A total of 41 patients experienced bleeding events. TEG analysis showed a significant decrease in ADP aggregation and increase in ADP inhibition. In ROC-analysis, TEG ADP aggregation and inhibition and Multiplate ADP aggregation showed moderate predictive values for bleeding events. The delta-ADP-Test (Multiplate) showed the strongest prediction of bleeding (area under the curve: 0.69). Adding platelet function and TEG markers to a model of clinical bleeding risk factors improved the prediction for bleeding events.CONCLUSION: This study indicates that thrombogenicity might be affected immediately after M-TEER probably due to changes in flow conditions. In particular, platelet aggregation involving the ADP receptor pathway significantly correlated with postprocedural bleeding events. Whether these results could guide peri-interventional antithrombotic therapy and improve peri- and postprocedural outcome requires further investigation.",

keywords = "M-TEER, bleeding, mitral regurgitation, platelet function, thromboelastography",

author = "Miriam Euper and J{\"u}rgen Schreieck and Mareike Bladt and Monika Zdanyte and Andreas Goldschmied and Manuel Sigle and Angiolillo, \{Dominick J\} and Gorog, \{Diana A\} and Jacobsen, \{Mia Ravn\} and Rikke S{\o}rensen and Dominik Rath and Meinrad Gawaz and Tobias Geisler",

note = "The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).",

year = "2025",

month = feb,

doi = "10.1055/s-0044-1790604",

language = "English",

volume = "125",

pages = "130--141",

journal = "Thrombosis and Haemostasis",

issn = "0340-6245",

publisher = "Georg Thieme Verlag",

number = "2",

}

TY - JOUR

T1 - Dynamics of Thrombogenicity and Platelet Function and Correlation with Bleeding Risk in Patients Undergoing M-TEER Using the PASCAL System

AU - Euper, Miriam

AU - Schreieck, Jürgen

AU - Bladt, Mareike

AU - Zdanyte, Monika

AU - Goldschmied, Andreas

AU - Sigle, Manuel

AU - Angiolillo, Dominick J

AU - Gorog, Diana A

AU - Jacobsen, Mia Ravn

AU - Sørensen, Rikke

AU - Rath, Dominik

AU - Gawaz, Meinrad

AU - Geisler, Tobias

N1 - The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

PY - 2025/2

Y1 - 2025/2

N2 - BACKGROUND: Transcatheter mitral valve repair is performed in a patient population at risk for thrombotic and bleeding events. The effects on platelet function and reactivity and their association with bleeding events after mitral transcatheter edge-to-edge therapy (M-TEER) have not been systematically examined.OBJECTIVES: We sought to investigate the association of different parameters of platelet function and thrombogenicity with bleeding events post M-TEER.METHODS: In this single-center study, 100 consecutive patients with mitral regurgitation receiving TEER were analyzed. Blood was taken directly from the guide-catheter in the left atrium before and after placing the device. Blood samples were analyzed using impedance aggregometry (Multiplate) and TEG6s. The results were compared pre- and postprocedural. The primary outcome was any bleeding complication according to the Bleeding Academic Research Consortium classification within 6 months.RESULTS: A total of 41 patients experienced bleeding events. TEG analysis showed a significant decrease in ADP aggregation and increase in ADP inhibition. In ROC-analysis, TEG ADP aggregation and inhibition and Multiplate ADP aggregation showed moderate predictive values for bleeding events. The delta-ADP-Test (Multiplate) showed the strongest prediction of bleeding (area under the curve: 0.69). Adding platelet function and TEG markers to a model of clinical bleeding risk factors improved the prediction for bleeding events.CONCLUSION: This study indicates that thrombogenicity might be affected immediately after M-TEER probably due to changes in flow conditions. In particular, platelet aggregation involving the ADP receptor pathway significantly correlated with postprocedural bleeding events. Whether these results could guide peri-interventional antithrombotic therapy and improve peri- and postprocedural outcome requires further investigation.

AB - BACKGROUND: Transcatheter mitral valve repair is performed in a patient population at risk for thrombotic and bleeding events. The effects on platelet function and reactivity and their association with bleeding events after mitral transcatheter edge-to-edge therapy (M-TEER) have not been systematically examined.OBJECTIVES: We sought to investigate the association of different parameters of platelet function and thrombogenicity with bleeding events post M-TEER.METHODS: In this single-center study, 100 consecutive patients with mitral regurgitation receiving TEER were analyzed. Blood was taken directly from the guide-catheter in the left atrium before and after placing the device. Blood samples were analyzed using impedance aggregometry (Multiplate) and TEG6s. The results were compared pre- and postprocedural. The primary outcome was any bleeding complication according to the Bleeding Academic Research Consortium classification within 6 months.RESULTS: A total of 41 patients experienced bleeding events. TEG analysis showed a significant decrease in ADP aggregation and increase in ADP inhibition. In ROC-analysis, TEG ADP aggregation and inhibition and Multiplate ADP aggregation showed moderate predictive values for bleeding events. The delta-ADP-Test (Multiplate) showed the strongest prediction of bleeding (area under the curve: 0.69). Adding platelet function and TEG markers to a model of clinical bleeding risk factors improved the prediction for bleeding events.CONCLUSION: This study indicates that thrombogenicity might be affected immediately after M-TEER probably due to changes in flow conditions. In particular, platelet aggregation involving the ADP receptor pathway significantly correlated with postprocedural bleeding events. Whether these results could guide peri-interventional antithrombotic therapy and improve peri- and postprocedural outcome requires further investigation.

KW - M-TEER

KW - bleeding

KW - mitral regurgitation

KW - platelet function

KW - thromboelastography

UR - https://www.scopus.com/pages/publications/85204901054

U2 - 10.1055/s-0044-1790604

DO - 10.1055/s-0044-1790604

M3 - Journal article

C2 - 39293482

SN - 0340-6245

VL - 125

SP - 130

EP - 141

JO - Thrombosis and Haemostasis

JF - Thrombosis and Haemostasis

IS - 2

ER -

Dynamics of Thrombogenicity and Platelet Function and Correlation with Bleeding Risk in Patients Undergoing M-TEER Using the PASCAL System

Abstract

Keywords

Access to Document

Other files and links

Fingerprint

Cite this