Platelet and Monocyte Activation After Transcatheter Aortic Valve Replacement (POTENT-TAVR): A Mechanistic Randomized Trial of Ticagrelor Versus Clopidogrel

The Platelet and Monocyte Activation After Transcatheter Aortic Valve Replacement trial was a randomized trial of clopidogrel vs. ticagrelor to test the hypothesis that high HRPR despite clopidogrel use after transcatheter aortic valve replacement (TAVR) contributes to postprocedural monocyte activation and elevated biomarkers of immuno-thrombosis. We find that those who were clopidogrel-responsive had lower levels of inflammatory monocytes 1 day after TAVR (Kruskal-Wallis test, Dunn’s posttest, ∗∗: p < 0.01), compared to those with HRPR on clopidogrel or those randomized to ticagrelor. However, ticagrelor did not lead to reductions in immunologic or thrombotic biomarkers, compared to clopidogrel. Thus, residual P2Y12 responsiveness does not appear to promote immune activation after TAVR; instead, clopidogrel metabolism or efficacy may be diminished as consequence or epiphenomenon of robust inflammation in the post-TAVR setting.