Author + information
- Wang Guocai and
- Jun Qin
Several studies have demonstrated coagulant system was activated after transcatheter closure of ASD, but changes of platelet function still remain controversial. Currently, it is not clear which anticoagulant regiment is more effective to prevent thrombosis and embolic events after device implantion. This study was to compare the effects of three anticoagulant regiments on coagulant state and platelet function following transcatheter closure of atrial septal defect (ASD).
A total 138 patients who underwent transcatheter closure of ASD were randomized into three groups to receive different anticoagulant therapy: unfractionated heparin (UFH) for 24 hours, low molecular weight heparin (LMWH) for 24 hours, and LMWH for 72 hours (pLMWH). Aspirin was given to all patients for 6 months after intervention. The laboratory measurements included beta-thromboglobulin (β-TG), platelet factor 4 (PF4) and prothrombin fragment 1+2 (F1+2) which were done before intervention as baseline, immediately after, and day 1, 2, 3, 7, 30 and 90 after intervention.
In 3 groups, β-TG, PF4 and F1+2 elevated immediately after implantation procedure. β-TG and PF4 declined slightly on day 1 and 2, and rose to a highest level on day 3, then fell down to baseline on day 7. The F1+2 gradually returned to baseline on day 90. However, the F1+2 in pLMWH group was markedly lower than that in UFH and LMWH groups on day 3. No thrombo-embolic events were noted during follow-up.
Transcatheter closure of ASD was associated with significant activation of both platelets and coagulation. These findings support an antithrombotic regiment after procedure including anticoagulant and antiplatelet agents. The F1+2 level fell down earlier in pLMWH group. However, there were no differences of clinical outcomes among three groups on day 90 after intervention. Therefore, a larger size and longer follow-up study is needed to further clarify this issue.