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

doi:10.3389/fcvm.2021.788137

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

Front Cardiovasc Med. 2021 Dec 22:8:788137. doi: 10.3389/fcvm.2021.788137. eCollection 2021.

Authors

Anne-Marije Hulshof^{1

2}, Renske H Olie^{2

3

4}, Minka J A Vries², Paul W M Verhezen¹, Paola E J van der Meijden², Hugo Ten Cate^{2

3

4}, Yvonne M C Henskens^{1

2}

Affiliations

¹ Central Diagnostic Laboratory, Maastricht University Medical Center+, Maastricht, Netherlands.
² Department of Biochemistry, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands.
³ Department of Internal Medicine, Maastricht University, Maastricht, Netherlands.
⁴ Thrombosis Expert Centre Maastricht, Maastricht University Medical Center+, Maastricht, Netherlands.

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.

Keywords: anticoagulants; antiplatelet drug; fibrinolysis; percutaneous coronary intervention; thromboelastometry (ROTEM®).