{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T22:14:20Z","timestamp":1772144060632,"version":"3.50.1"},"reference-count":46,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,12,22]],"date-time":"2021-12-22T00:00:00Z","timestamp":1640131200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p><jats:bold>Aims:<\/jats:bold> 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.<\/jats:p><jats:p><jats:bold>Methods and Results:<\/jats:bold> In this prospective cohort, 440 patients treated with double antithrombotic therapy after recent PCI and with \u22653 risk factors for either ischemic or bleeding complications were included and compared with a control group (<jats:italic>n<\/jats:italic> = 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, <jats:italic>n<\/jats:italic> = 323), a vitamin K antagonist (VKA, <jats:italic>n<\/jats:italic> = 69) or a direct oral anticoagulant (DOAC, <jats:italic>n<\/jats:italic> = 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 &amp;gt; 0.97). Furthermore, EXTEM CT was significantly prolonged in DAPT patients with bleeding complications during follow-up (68 [62\u201370] vs. 62 [57\u201368], <jats:italic>p<\/jats:italic> = 0.030).<\/jats:p><jats:p><jats:bold>Conclusion:<\/jats:bold> 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.<\/jats:p>","DOI":"10.3389\/fcvm.2021.788137","type":"journal-article","created":{"date-parts":[[2021,12,22]],"date-time":"2021-12-22T05:14:07Z","timestamp":1640150047000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Rotational Thromboelastometry in High-Risk Patients on Dual Antithrombotic Therapy After Percutaneous Coronary Intervention"],"prefix":"10.3389","volume":"8","author":[{"given":"Anne-Marije","family":"Hulshof","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renske H.","family":"Olie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Minka J. A.","family":"Vries","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paul W. M.","family":"Verhezen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paola E. J.","family":"van der Meijden","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hugo","family":"ten Cate","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yvonne M. C.","family":"Henskens","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,12,22]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2574","DOI":"10.1161\/CIR.0b013e31823a5596","article-title":"2011 ACCF\/AHA\/SCAI Guideline for Percutaneous Coronary Intervention: executive summary: a report of the American College of Cardiology Foundation\/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions","volume":"124","author":"Levine","year":"2011","journal-title":"Circulation."},{"key":"B2","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1093\/eurheartj\/ehy855","article-title":"2018 ESC\/EACTS Guidelines on myocardial revascularization","volume":"40","author":"Neumann","year":"2019","journal-title":"Eur Heart J."},{"key":"B3","doi-asserted-by":"publisher","first-page":"3155","DOI":"10.1093\/eurheartj\/ehu298","article-title":"Management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and\/or undergoing percutaneous coronary or valve interventions: a joint consensus document of the European Society of Cardiology Working Group on Thrombosis, European Heart Rhythm Association (EHRA), European Association of Percutaneous Cardiovascular Interventions (EAPCI) and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS) and Asia-Pacific Heart Rhythm Society (APHRS)","volume":"35","author":"Lip","year":"2014","journal-title":"Eur Heart J."},{"key":"B4","doi-asserted-by":"publisher","first-page":"e125","DOI":"10.1161\/CIR.0000000000000665","article-title":"2019 AHA\/ACC\/HRS Focused Update of the 2014 AHA\/ACC\/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons","volume":"140","author":"January","year":"2019","journal-title":"Circulation"},{"key":"B5","doi-asserted-by":"publisher","first-page":"2001","DOI":"10.1056\/NEJMoa0706482","article-title":"Prasugrel versus clopidogrel in patients with acute coronary syndromes","volume":"357","author":"Wiviott","year":"2007","journal-title":"N Engl J Med."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1045","DOI":"10.1056\/NEJMoa0904327","article-title":"Ticagrelor versus clopidogrel in patients with acute coronary syndromes","volume":"361","author":"Wallentin","year":"2009","journal-title":"N Engl J Med."},{"key":"B7","doi-asserted-by":"publisher","first-page":"e123","DOI":"10.1161\/CIR.0000000000000404","article-title":"2016 ACC\/AHA Guideline Focused Update on Duration of Dual Antiplatelet Therapy in Patients With Coronary Artery Disease: A Report of the American College of Cardiology\/American Heart Association Task Force on Clinical Practice Guidelines: An Update of the 2011 ACCF\/AHA\/SCAI Guideline for Percutaneous Coronary Intervention, 2011 ACCF\/AHA Guideline for Coronary Artery Bypass Graft Surgery, 2012 ACC\/AHA\/ACP\/AATS\/PCNA\/SCAI\/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease, 2013 ACCF\/AHA Guideline for the Management of ST-Elevation Myocardial Infarction, 2014 AHA\/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes, and 2014 ACC\/AHA Guideline on Perioperative Cardiovascular Evaluation and Management of Patients Undergoing Noncardiac Surgery","volume":"134","author":"Levine","year":"2016","journal-title":"Circulation."},{"key":"B8","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1111\/ijlh.12816","article-title":"Direct oral anticoagulants: when to consider laboratory testing?","volume":"40","author":"Ten Cate","year":"2018","journal-title":"Int J Lab Hematol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"133","DOI":"10.2147\/VHRM.S44469","article-title":"Platelet function tests: a comparative review","volume":"11","author":"Paniccia","year":"2015","journal-title":"Vasc Health Risk Manag."},{"key":"B10","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1055\/s-0035-1570083","article-title":"Platelet function testing in patients on antiplatelet medications","volume":"42","author":"Gross","year":"2016","journal-title":"Semin Thromb Hemost."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1521","DOI":"10.1016\/j.jcin.2019.03.034","article-title":"Updated expert consensus statement on platelet function and genetic testing for guiding P2Y12 receptor inhibitor treatment in percutaneous coronary intervention","volume":"12","author":"Sibbing","year":"2019","journal-title":"JACC Cardiovasc Interv."},{"key":"B12","doi-asserted-by":"publisher","first-page":"295","DOI":"10.1093\/eurheartj\/ehy656","article-title":"Impaired endogenous fibrinolysis in ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention is a predictor of recurrent cardiovascular events: the RISK PPCI study","volume":"40","author":"Farag","year":"2019","journal-title":"Eur Heart J."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1078","DOI":"10.1093\/eurheartj\/ehy013","article-title":"Fibrin clot properties independently predict adverse clinical outcome following acute coronary syndrome: a PLATO substudy","volume":"39","author":"Sumaya","year":"2018","journal-title":"Eur Heart J."},{"key":"B14","doi-asserted-by":"publisher","first-page":"332","DOI":"10.1097\/EJA.0000000000000630","article-title":"Management of severe perioperative bleeding: guidelines from the European Society of Anaesthesiology: First update 2016","volume":"34","author":"Kozek-Langenecker","year":"2017","journal-title":"Eur J Anaesthesiol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"R30","DOI":"10.1186\/cc13721","article-title":"Utility of thromboelastography and\/or thromboelastometry in adults with sepsis: a systematic review","volume":"18","author":"Muller","year":"2014","journal-title":"Crit Care."},{"key":"B16","doi-asserted-by":"publisher","first-page":"3","DOI":"10.1186\/s12959-017-0160-2","article-title":"Detecting clinically relevant rivaroxaban or dabigatran levels by routine coagulation tests or thromboelastography in a cohort of patients with atrial fibrillation","volume":"16","author":"Henskens","year":"2018","journal-title":"Thromb J."},{"key":"B17","doi-asserted-by":"publisher","first-page":"751","DOI":"10.3109\/09537104.2016.1173665","article-title":"Early platelet recovery following cardiac surgery with cardiopulmonary bypass","volume":"27","author":"Van Poucke","year":"2016","journal-title":"Platelets."},{"key":"B18","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1007\/s12471-021-01606-2","article-title":"Antithrombotic therapy in high-risk patients after percutaneous coronary intervention; study design, cohort profile and incidence of adverse events","volume":"29","author":"Olie","year":"2021","journal-title":"Neth Heart J."},{"key":"B19","doi-asserted-by":"publisher","first-page":"767","DOI":"10.1002\/rth2.12114","article-title":"Preoperative screening for bleeding disorders: A comprehensive laboratory assessment of clinical practice","volume":"2","author":"Vries","year":"2018","journal-title":"Res Prac Thromb Haemost."},{"key":"B20","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12959-016-0076-2","article-title":"Validation of a modified thromboelastometry approach to detect changes in fibrinolytic activity","volume":"14","author":"Kuiper","year":"2016","journal-title":"Thromb J."},{"key":"B21","doi-asserted-by":"publisher","first-page":"2736","DOI":"10.1161\/CIRCULATIONAHA.110.009449","article-title":"Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium","volume":"123","author":"Mehran","year":"2011","journal-title":"Circulation."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1424","DOI":"10.1161\/CIRCULATIONAHA.111.060871","article-title":"Validation of the Bleeding Academic Research Consortium definition of bleeding in patients with coronary artery disease undergoing percutaneous coronary intervention","volume":"125","author":"Ndrepepa","year":"2012","journal-title":"Circulation."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1354","DOI":"10.1161\/01.ATV.20.5.1354","article-title":"Influence of fibrin network conformation and fibrin fiber diameter on fibrinolysis speed: dynamic and structural approaches by confocal microscopy","volume":"20","author":"Collet","year":"2000","journal-title":"Arterioscler Thromb Vasc Biol."},{"key":"B24","doi-asserted-by":"publisher","first-page":"24259","DOI":"10.1016\/S0021-9258(18)35759-4","article-title":"The effect of fibrin structure on fibrinolysis","volume":"267","author":"Gabriel","year":"1992","journal-title":"J Biol Chem."},{"key":"B25","doi-asserted-by":"publisher","first-page":"3050","DOI":"10.1161\/01.CIR.99.23.3050","article-title":"Plasminogen activator inhibitor-1 is a major determinant of arterial thrombolysis resistance","volume":"99","author":"Zhu","year":"1999","journal-title":"Circulation."},{"key":"B26","doi-asserted-by":"publisher","first-page":"276","DOI":"10.1161\/ATVBAHA.109.194936","article-title":"Altered plasma fibrin clot properties are associated with in-stent thrombosis","volume":"30","author":"Undas","year":"2010","journal-title":"Arterioscler Thromb Vasc Biol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"790","DOI":"10.1111\/j.1538-7836.2010.03739.x","article-title":"Dabigatran enhances clot susceptibility to fibrinolysis by mechanisms dependent on and independent of thrombin-activatable fibrinolysis inhibitor","volume":"8","author":"Ammollo","year":"2010","journal-title":"J Thromb Haemost."},{"key":"B28","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1007\/s11239-019-01851-8","article-title":"A. direct oral anticoagulant edoxaban accelerated fibrinolysis via enhancement of plasmin generation in human plasma: dependent on thrombin-activatable fibrinolysis inhibitor","volume":"48","author":"Morishima","year":"2019","journal-title":"J Thromb Thrombolysis."},{"key":"B29","doi-asserted-by":"publisher","first-page":"e100","DOI":"10.1016\/j.thromres.2012.11.029","article-title":"Whole blood clots are more resistant to lysis than plasma clots\u2013greater efficacy of rivaroxaban","volume":"131","author":"Varin","year":"2013","journal-title":"Thromb Res."},{"key":"B30","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1007\/s10238-018-0490-9","article-title":"Plasma clot formation and clot lysis to compare effects of different anticoagulation treatments on hemostasis in patients with atrial fibrillation","volume":"18","author":"Konigsbrugge","year":"2018","journal-title":"Clin Exp Med."},{"key":"B31","doi-asserted-by":"publisher","first-page":"2276","DOI":"10.1111\/jth.14281","article-title":"Rivaroxaban and apixaban induce clotting factor Xa fibrinolytic activity","volume":"16","author":"Carter","year":"2018","journal-title":"J Thromb Haemost."},{"key":"B32","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1016\/j.blre.2006.11.001","article-title":"Thrombin generation and fibrin clot structure","volume":"21","author":"Wolberg","year":"2007","journal-title":"Blood Rev."},{"key":"B33","doi-asserted-by":"publisher","first-page":"525","DOI":"10.26402\/jpp.2018.4.02","article-title":"Antithrombotic medications and their impact on fibrin clot structure and function","volume":"29","author":"Undas","year":"2018","journal-title":"J Physiol Pharmacol."},{"key":"B34","doi-asserted-by":"publisher","first-page":"40","DOI":"10.1097\/FJC.0000000000000631","article-title":"Platelet reactivity in patients on aspirin and clopidogrel therapy measured by a new bedside whole-blood assay","volume":"73","author":"Polzin","year":"2019","journal-title":"J Cardiovasc Pharmacol."},{"key":"B35","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1111\/ijlh.12744","article-title":"Impact of four direct oral anticoagulants on rotational thromboelastometry (ROTEM)","volume":"40","author":"Seyve","year":"2018","journal-title":"Int J Lab Hematol."},{"key":"B36","doi-asserted-by":"publisher","first-page":"157","DOI":"10.2450\/2018.0028-18","article-title":"Reversal of apixaban induced alterations in haemostasis by different coagulation factor concentrates in patients after hip or knee replacement surgery","volume":"17","author":"Schmidt","year":"2019","journal-title":"Blood Transfus."},{"key":"B37","doi-asserted-by":"publisher","first-page":"403","DOI":"10.1021\/acsbiomaterials.5b00536","article-title":"A fibrin cross-linking polymer enhances clot formation similar to factor concentrates and tranexamic acid in an in vitro model of coagulopathy","volume":"2","author":"Chan","year":"2016","journal-title":"ACS Biomater Sci Eng."},{"key":"B38","doi-asserted-by":"publisher","first-page":"487","DOI":"10.1182\/blood-2015-06-652214","article-title":"Thrombin and fibrinogen gamma' impact clot structure by marked effects on intrafibrillar structure and protofibril packing","volume":"127","author":"Domingues","year":"2016","journal-title":"Blood."},{"key":"B39","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1080\/00365513.2017.1403038","article-title":"Influence of selected antithrombotic treatment on thromboelastometric results","volume":"78","author":"Holck","year":"2018","journal-title":"Scand J Clin Lab Invest."},{"key":"B40","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1016\/j.thromres.2009.06.016","article-title":"A randomised study comparing the antiplatelet and antiinflammatory effect of clopidogrel 150 mg\/day versus 75 mg\/day in patients with ST-segment elevation acute myocardial infarction and poor responsiveness to clopidogrel: results from the DOUBLE study","volume":"125","author":"Palmerini","year":"2010","journal-title":"Thromb Res."},{"key":"B41","doi-asserted-by":"publisher","first-page":"948","DOI":"10.1007\/s00101-012-2091-4","article-title":"Effect of rivaroxaban on blood coagulation using the viscoelastic coagulation test ROTEM","volume":"61","author":"Casutt","year":"2012","journal-title":"Anaesthesist."},{"key":"B42","doi-asserted-by":"publisher","first-page":"1076029620983902","DOI":"10.1177\/1076029620983902","article-title":"Impact of dabigatran treatment on rotation thromboelastometry","volume":"27","author":"Sokol","year":"2021","journal-title":"Clin Appl Thromb Hemost."},{"key":"B43","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1016\/j.thromres.2017.03.018","article-title":"Whole blood coagulation assays ROTEM and T-TAS to monitor dabigatran treatment","volume":"153","author":"Taune","year":"2017","journal-title":"Thromb Res."},{"key":"B44","doi-asserted-by":"publisher","first-page":"2567","DOI":"10.1161\/01.ATV.0000241589.52950.4c","article-title":"Altered fibrin architecture is associated with hypofibrinolysis and premature coronary atherothrombosis","volume":"26","author":"Collet","year":"2006","journal-title":"Arterioscler Thromb Vasc Biol."},{"key":"B45","doi-asserted-by":"publisher","first-page":"535","DOI":"10.1055\/s-0038-1650618","article-title":"Proneness to formation of tight and rigid fibrin gel structures in men with myocardial infarction at a young age","volume":"76","author":"Fatah","year":"1996","journal-title":"Thromb Haemost."},{"key":"B46","doi-asserted-by":"publisher","first-page":"1499","DOI":"10.1161\/STROKEAHA.108.532812","article-title":"Altered fibrin clot structure\/function in patients with cryptogenic ischemic stroke","volume":"40","author":"Undas","year":"2009","journal-title":"Stroke."}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2021.788137\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,22]],"date-time":"2021-12-22T05:14:13Z","timestamp":1640150053000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2021.788137\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,22]]},"references-count":46,"alternative-id":["10.3389\/fcvm.2021.788137"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2021.788137","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,22]]},"article-number":"788137"}}