Perioperative changes in coagulation and hemostasis assessed using thromboelastography and their association with hypoattenuated leaflet thickening after transcatheter aortic valve implantation: a retrospective, single-center observational study

To evaluate perioperative changes in coagulation and hemostatic function during transfemoral transcatheter aortic valve implantation (TAVI) using thromboelastography (TEG) and to investigate their association with hypoattenuated leaflet thickening (HALT). In this retrospective, single-center study, 30 patients undergoing transfemoral TAVI were evaluated using TEG6s at three time points: after anesthesia induction and before heparin administration (T0), after protamine administration (T1), and on postoperative day 1 (T2). HALT was assessed using contrast-enhanced computed tomography 1 week after TAVI. Seven patients (23%) developed HALT. After Benjamini–Hochberg correction, patients with HALT had significantly lower maximum amplitude values for citrated rapid thromboelastography (CRT), citrated kaolin with heparinase (CKH), and citrated kaolin (CK) at T0 and T2, whereas only CK maximum amplitude remained significantly lower at T1. CRT clot kinetics were significantly prolonged at T0 and T2, whereas CKH and CK clot kinetics were significantly prolonged at T2. CRT reaction time was significantly prolonged at T1. Fibrinogen levels were significantly lower in the HALT group at T0 and T1. These findings suggest that HALT is associated with reduced clot strength, slower clot kinetics, and lower fibrinogen levels during the perioperative period.