{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T06:35:16Z","timestamp":1790836516872,"version":"4.1.0"},"reference-count":30,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2019,4,12]],"date-time":"2019-04-12T00:00:00Z","timestamp":1555027200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>The impact of antithrombotic regimen and platelet inhibition extent on subclinical leaflet thrombosis (SLT) detected by cardiac multidetector computed tomography (MDCT) after transcatheter aortic valve replacement (TAVR) is not well established. Hypoattenuation affecting motion (HAM) has been proposed as a surrogate marker of SLT, and is characterized by hypoattenuated leaflet thickening (HALT) and concomitant reduction in leaflet motion (RELM). We sought to investigate (i) the prevalence of HAM and HALT after TAVR detected by MDCT, (ii) the predictors of SLT, (iii) the impact of oral anticoagulant (OAC) and platelet inhibition extent assessed by platelet reactivity index vasodilator stimulated phosphoprotein (PRI-VASP) and closure time adenosine diphosphate (CT-ADP) on SLT. Of 187 consecutive patients who underwent TAVR from 1 August 2017 to 31 March 2018, 90 of them had cardiac CT at relevant follow-up. Clinical, biological, echocardiographic, procedural characteristics and treatments were collected before, at discharge, and 1 year after TAVR. P2Y12 platelet inhibition extent and primary haemostasis disorders were investigated using platelet PRI-VASP and CT-ADP point-of-care assays. Eighty-five post-TAVR CTs out of 90 were ranked for clarity and assessed with sufficient diagnostic quality. HAM was evidenced in 13 patients (15.3%) and HALT in 30 patients (35%). Procedural characteristics, including aortic valve calcium score, annulus size, or procedural heparin regimens, were equivalent between groups. Likewise, no impact of P2Y12 inhibition (PRI-VASP) nor primary haemostasis disorders (CT-ADP) on SLT could be evidenced. No impact of SLT on valve deterioration evaluated by transthoracic echocardiography (TTE) and clinical events could be established at 12 months follow-up. By multivariate analysis, lack of oral anticoagulant therapy at discharge (HR 12.130 CI 95% (1.394\u2013150.582); p = 0.028) and higher haemoglobin levels were evidenced as the sole independent predictors of SLT. In four patients with HAM, MDCT follow-up was obtained after initiation of OAC therapy and showed a complete regression of HAM. SLT was evidenced in a sizeable proportion of patients treated by TAVR and was mainly determined by the lack of oral anticoagulant therapy. Conversely, no impact of platelet inhibition extent on SLT could be evidenced.<\/jats:p>","DOI":"10.3390\/jcm8040506","type":"journal-article","created":{"date-parts":[[2019,4,12]],"date-time":"2019-04-12T12:55:04Z","timestamp":1555073704000},"page":"506","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Impact of Antithrombotic Regimen and Platelet Inhibition Extent on Leaflet Thrombosis Detected by Cardiac MDCT after Transcatheter Aortic Valve Replacement"],"prefix":"10.3390","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9435-0436","authenticated-orcid":false,"given":"Charline","family":"Jimenez","sequence":"first","affiliation":[{"name":"Universit\u00e9 de Strasbourg, P\u00f4le d\u2019Activit\u00e9 M\u00e9dico-Chirurgicale Cardio-Vasculaire, Nouvel H\u00f4pital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0179-5784","authenticated-orcid":false,"given":"Micka\u00ebl","family":"Ohana","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Strasbourg, D\u00e9partement de Radiologie, Nouvel H\u00f4pital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Marchandot","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Strasbourg, P\u00f4le d\u2019Activit\u00e9 M\u00e9dico-Chirurgicale Cardio-Vasculaire, Nouvel H\u00f4pital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marion","family":"Kibler","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Strasbourg, P\u00f4le d\u2019Activit\u00e9 M\u00e9dico-Chirurgicale Cardio-Vasculaire, Nouvel H\u00f4pital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adrien","family":"Carmona","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Strasbourg, P\u00f4le d\u2019Activit\u00e9 M\u00e9dico-Chirurgicale Cardio-Vasculaire, Nouvel H\u00f4pital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilou","family":"Peillex","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Strasbourg, P\u00f4le d\u2019Activit\u00e9 M\u00e9dico-Chirurgicale Cardio-Vasculaire, Nouvel H\u00f4pital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joe","family":"Heger","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Strasbourg, P\u00f4le d\u2019Activit\u00e9 M\u00e9dico-Chirurgicale Cardio-Vasculaire, Nouvel H\u00f4pital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonin","family":"Trimaille","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Strasbourg, P\u00f4le d\u2019Activit\u00e9 M\u00e9dico-Chirurgicale Cardio-Vasculaire, Nouvel H\u00f4pital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kensuke","family":"Matsushita","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Strasbourg, P\u00f4le d\u2019Activit\u00e9 M\u00e9dico-Chirurgicale Cardio-Vasculaire, Nouvel H\u00f4pital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antje","family":"Reydel","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Strasbourg, P\u00f4le d\u2019Activit\u00e9 M\u00e9dico-Chirurgicale Cardio-Vasculaire, Nouvel H\u00f4pital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S\u00e9bastien","family":"Hess","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Strasbourg, P\u00f4le d\u2019Activit\u00e9 M\u00e9dico-Chirurgicale Cardio-Vasculaire, Nouvel H\u00f4pital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laurence","family":"Jesel","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Strasbourg, P\u00f4le d\u2019Activit\u00e9 M\u00e9dico-Chirurgicale Cardio-Vasculaire, Nouvel H\u00f4pital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France"},{"name":"UMR INSERM 1260 Regenerative Nanomedicine, Universit\u00e9 de Strasbourg, 67000 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick","family":"Ohlmann","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Strasbourg, P\u00f4le d\u2019Activit\u00e9 M\u00e9dico-Chirurgicale Cardio-Vasculaire, Nouvel H\u00f4pital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier","family":"Morel","sequence":"additional","affiliation":[{"name":"Universit\u00e9 de Strasbourg, P\u00f4le d\u2019Activit\u00e9 M\u00e9dico-Chirurgicale Cardio-Vasculaire, Nouvel H\u00f4pital Civil, Centre Hospitalier Universitaire, 67000 Strasbourg, France"},{"name":"UMR INSERM 1260 Regenerative Nanomedicine, Universit\u00e9 de Strasbourg, 67000 Strasbourg, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2019,4,12]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1093\/ejcts\/ezx324","article-title":"2017 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"52","author":"Falk","year":"2017","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1016\/j.jacc.2017.03.011","article-title":"2017 AHA\/ACC Focused Update of the 2014 AHA\/ACC Guideline for the Management of Patients with Valvular Heart Disease","volume":"70","author":"Nishimura","year":"2017","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Ranasinghe, M., Peter, K., and McFadyen, J. (2019). Thromboembolic and Bleeding Complications in Transcatheter Aortic Valve Implantation: Insights on Mechanisms, Prophylaxis and Therapy. J. Clin. Med., 8.","DOI":"10.3390\/jcm8020280"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1637","DOI":"10.1016\/j.jacc.2016.07.747","article-title":"Late Outcomes of Transcatheter Aortic Valve Replacement in High-Risk Patients","volume":"68","author":"Gilard","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1735","DOI":"10.1253\/circj.CJ-17-1363","article-title":"Subclinical Leaflet Thrombosis in Transcatheter Aortic Valve Replacement Detected by Multidetector Computed Tomography\u2014A Review of Current Evidence","volume":"82","author":"Rashid","year":"2018","journal-title":"Circ. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1016\/j.jcmg.2017.02.005","article-title":"Systematic CT Methodology for the Evaluation of Subclinical Leaflet Thrombosis","volume":"10","author":"Jilaihawi","year":"2017","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1277","DOI":"10.1016\/j.jcin.2018.01.263","article-title":"Platelet Reactivity and Risk of Ischemic Stroke After Coronary Drug-Eluting Stent Implantation","volume":"11","author":"Giustino","year":"2018","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2261","DOI":"10.1016\/j.jacc.2013.07.101","article-title":"Consensus and Update on the Definition of On-Treatment Platelet Reactivity to Adenosine Diphosphate Associated with Ischemia and Bleeding","volume":"62","author":"Tantry","year":"2013","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1762","DOI":"10.1093\/eurheartj\/ehv104","article-title":"Bleeding and stent thrombosis on P2Y12-inhibitors: Collaborative analysis on the role of platelet reactivity for risk stratification after percutaneous coronary intervention","volume":"36","author":"Aradi","year":"2015","journal-title":"Eur. Heart J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"975","DOI":"10.1016\/j.echo.2009.07.013","article-title":"Recommendations for Evaluation of Prosthetic Valves with Echocardiography and Doppler Ultrasound","volume":"22","author":"Zoghbi","year":"2009","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2403","DOI":"10.1093\/eurheartj\/ehs255","article-title":"Updated standardized endpoint definitions for transcatheter aortic valve implantation: The Valve Academic Research Consortium-2 consensus document","volume":"33","author":"Kappetein","year":"2012","journal-title":"Eur. Heart J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2383","DOI":"10.1016\/S0140-6736(17)30757-2","article-title":"Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves: An observational study","volume":"389","author":"Chakravarty","year":"2017","journal-title":"Lancet"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"2201","DOI":"10.1093\/eurheartj\/ehx369","article-title":"Natural history of subclinical leaflet thrombosis affecting motion in bioprosthetic aortic valves","volume":"38","author":"Sondergaard","year":"2017","journal-title":"Eur. Heart J."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e001596","DOI":"10.1161\/CIRCINTERVENTIONS.114.001596","article-title":"Early Aortic Transcatheter Heart Valve Thrombosis: Diagnostic Value of Contrast-Enhanced Multidetector Computed Tomography","volume":"8","author":"Leetmaa","year":"2015","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2059","DOI":"10.1016\/j.jacc.2016.08.010","article-title":"Transcatheter Aortic Valve Thrombosis","volume":"68","author":"Hansson","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2263","DOI":"10.1093\/eurheartj\/ehv526","article-title":"Early hypo-attenuated leaflet thickening in balloon-expandable transcatheter aortic heart valves","volume":"37","author":"Pache","year":"2016","journal-title":"Eur. Heart J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1598","DOI":"10.1161\/CIRCULATIONAHA.117.029479","article-title":"The Fluid Mechanics of Transcatheter Heart Valve Leaflet Thrombosis in the Neosinus","volume":"136","author":"Midha","year":"2017","journal-title":"Circulation"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1016\/j.jcmg.2016.11.009","article-title":"Leaflet Thrombosis in Surgically Explanted or Post-Mortem TAVR Valves","volume":"10","author":"Mangione","year":"2017","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"488","DOI":"10.1093\/ejcts\/ezs359","article-title":"Traumatic leaflet injury during the use of percutaneous valves: A comparative study of balloon- and self-expandable valved stents","volume":"43","author":"Amahzoune","year":"2013","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1016\/j.ijcard.2016.03.130","article-title":"Clinical and subclinical leaflet thrombosis in bioprosthetic aortic valves: A manifestation of Kounis syndrome?","volume":"214","author":"Kounis","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1160\/TH15-03-0267","article-title":"Platelet activation is less enhanced in the new balloon expandable Edwards Sapien 3 valve compared to its predecessor model (Edwards Sapien XT)","volume":"115","author":"Voesch","year":"2016","journal-title":"Thromb. Haemost."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1055\/s-0038-1639352","article-title":"CT-ADP Point-of-Care Assay Predicts 30-Day Paravalvular Aortic Regurgitation and Bleeding Events following Transcatheter Aortic Valve Replacement","volume":"118","author":"Kibler","year":"2018","journal-title":"Thromb. Haemost."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2139","DOI":"10.1016\/j.jacc.2018.08.2143","article-title":"Primary Hemostatic Disorders and Late Major Bleeding After Transcatheter Aortic Valve Replacement","volume":"72","author":"Kibler","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.jcin.2018.08.008","article-title":"Impact of On-Clopidogrel Platelet Reactivity on Incidence of Hypoattenuated Leaflet Thickening After Transcatheter Aortic Valve Replacement","volume":"12","author":"Hromek","year":"2019","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1007\/s00392-016-1052-3","article-title":"Course of early subclinical leaflet thrombosis after transcatheter aortic valve implantation with or without oral anticoagulation","volume":"106","author":"Ruile","year":"2017","journal-title":"Clin. Res. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.jcmg.2018.06.028","article-title":"Transcatheter Aortic Heart Valves","volume":"12","author":"Sellers","year":"2019","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1016\/j.jacc.2015.10.097","article-title":"Incidence, Timing, and Predictors of Valve Hemodynamic Deterioration After Transcatheter Aortic Valve Replacement","volume":"67","author":"Wijeysundera","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1164","DOI":"10.1016\/j.jcin.2018.04.006","article-title":"Medium-Term Follow-Up of Early Leaflet Thrombosis After Transcatheter Aortic Valve Replacement","volume":"11","author":"Ruile","year":"2018","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"256","DOI":"10.1080\/24748706.2017.1366086","article-title":"Clinical or Symptomatic Leaflet Thrombosis Following Transcatheter Aortic Valve Replacement: Insights from the U.S. FDA MAUDE Database","volume":"1","author":"Hafiz","year":"2017","journal-title":"Struct. Heart"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"2605","DOI":"10.1016\/j.jacc.2014.08.052","article-title":"Incidence, Predictors, and Prognostic Impact of Late Bleeding Complications After Transcatheter Aortic Valve Replacement","volume":"64","author":"Cohen","year":"2014","journal-title":"J. Am. Coll. Cardiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/4\/506\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T12:45:00Z","timestamp":1760186700000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/8\/4\/506"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,4,12]]},"references-count":30,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2019,4]]}},"alternative-id":["jcm8040506"],"URL":"https:\/\/doi.org\/10.3390\/jcm8040506","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,4,12]]}}}