1. Hemostatic biomarkers and antithrombotic strategy in percutaneous left atrial interventions
- Subjects
PHOSPHATIDYLSERINE EXPOSURE ,PLATELET ACTIVATION ,Patent/complications ,Fibrinolytic Agents/pharmacology ,Thromboembolism/drug therapy ,ASD ,Hemostatics ,Thrombosis/complications ,MEDICAL THERAPY ,Septal Occluder Device/adverse effects ,Anticoagulation ,PROCOAGULANT ACTIVITY ,PFO ,Humans ,Atrial Appendage/surgery ,Retrospective Studies ,Heart Diseases/complications ,Hemostasis ,Antiplatelet therapy ,AMPLATZER CARDIAC PLUG ,APPENDAGE CLOSURE DEVICE ,THROMBUS FORMATION ,Treatment Outcome ,LAA closure ,Cardiac Catheterization/adverse effects ,SEPTAL-DEFECTS ,PATENT FORAMEN OVALE ,TRANSCATHETER CLOSURE ,Atrial Fibrillation/complications ,Biomarkers ,Foramen Ovale - 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.
- Published
- 2022