PB1358 - Platelet Function Testing in Patients with Liver Cirrhosis and TIPS Implantation

Tuesday, June 27, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

AN

Asala Nassar

Medical Student
Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany
Freiburg, Baden-Wurttemberg, Germany

Co-Author(s)

PH

Patrick Huber

Physician
Department of Medicine II, University Hospital Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Freiburg, Baden-Wurttemberg, Germany
DS

Daniela Stallmann

Technical Assistant
Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany
Freiburg, Baden-Wurttemberg, Germany
DS

Diana Sharipova

Physician
Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany
Freiburg, Baden-Wurttemberg, Germany
Muataz Ali Hamad

PhD Student
Department of Cardiology and Angiology I, Heart Center, University of Freiburg, Freiburg, Germany
Freiburg, Baden-Wurttemberg, Germany
DD

Daniel Duerschmied

Director of Department of Medicine I
Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
Mannheim, Baden-Wurttemberg, Germany
DB

Dominik Bettinger

Senior Physician
Department of Medicine II, University Hospital Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
Freiburg, Baden-Wurttemberg, Germany
KK

Krystin Krauel

Research Group Leader
Department of Cardiology, Angiology, Haemostaseology and Medical Intensive Care, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
Mannheim, Baden-Wurttemberg, Germany

Background: Transjugular intrahepatic portosystemic shunt (TIPS) implantation is an effective treatment of portal hypertension in patients with decompensated liver cirrhosis. However, some patients develop TIPS thrombosis with recurrence of portal hypertension. The role of platelets in TIPS thrombosis and the necessity of anti-platelet therapy is unclear.

Aims: To study platelet function in patients with liver cirrhosis before and after TIPS implantation.

Methods: Platelet aggregation was tested in peripheral and portal vein blood patient samples on the day of TIPS implantation (D0), D4 and D30 following the procedure (platelet count above 100000/µL, aspirin starting D5) using whole blood impedance aggregometry (WBIA) and light transmission aggregometry (LTA). In addition, surface platelet activation markers (P-selectin, activated GPIIb/IIIa) and platelet-neutrophil complexes (PNCs) were assessed using flow cytometry. Thrombin receptor activating peptide 6 (TRAP-6), adenosine diphosphate (ADP) and arachidonic acid (AA) were used as agonists. Healthy subjects were included as controls. The study was approved by the ethical committee of the University of Freiburg.

Results: Agonist-induced platelet aggregation was reduced (WBIA: TRAP-6 P< 0.01, ADP P< 0.01, AA P< 0.001; LTA: TRAP-6 P=0.13, ADP P=0.05, AA P< 0.01) in patients (D0, n=13) compared with healthy subjects (n=9). While surface activation markers at baseline were negligibly low, the percentage of PNCs was higher in patients than in controls (P < 0.05). ADP-induced P-selectin expression was increased (P < 0.001), whereas TRAP-6-induced GPIIb/IIIa activation was impaired (P < 0.001) in patients versus controls. PNC formation in response to agonists was not different between groups. Results did not differ between peripheral and portal vein blood of patients (D0, n=10) and did not change over time (D0, D4, D30) following TIPS implantation (n=9).

Conclusion(s): Patients with decompensated liver cirrhosis have in vitro platelet aggregation defects in response to various agonists that maintain following TIPS implantation. Thus, the usefulness of anti-platelet medication to prevent TIPS thrombosis is questionable.