Predictors and clinical impact of pre‐existing and acquired thrombocytopenia following transcatheter aortic valve replacement
- 30 September 2014
- journal article
- research article
- Published by Wiley in Catheterization and Cardiovascular Interventions
- Vol. 85 (1), 118-129
- https://doi.org/10.1002/ccd.25668
Abstract
Background Data are limited regarding transcatheter aortic valve replacement (TAVR)‐related thrombocytopenia (TP). We sought to thoroughly characterize the presence, clinical impact, and severity of TP associated with TAVR. Methods and Results Data were collected from 90 patients who underwent TAVR using the Edwards SAPIEN valve (59 TF, 29 TA, 2 Tao). Platelet counts were evaluated peri‐procedurally and for 8 days following TAVR. Platelet levels were compared and patients were divided into a no TP (No‐TP) group 1, acquired (new) TP (NTP) group 2, pre‐existing (pre‐TAVR) TP (PTP) group 3, and further stratified based on the severity of TP: mild (M) TP (100–149 × 103 cell/µL) and moderate–severe (MS) TP (3 cell/µL). Pre‐TAVR point prevalence and post‐TAVR incidence of TP were 40% and 79%, respectively (P < 0.001); nadir platelet count in all groups occurred day 4 post‐TAVR. Baseline predictors for developing MS TP in groups 2–3 included baseline TP, leaner body mass, smaller pre‐procedural aortic valve area, higher peak aortic jet velocity, and worsening baseline renal function. Development of “major” TP (nadir platelet count <100 × 103 cell/µL, ≥50% decrease) predicted a higher risk of major vascular complications (OR 2.78 [95% CI, 1.58–3.82]) and major bleeding (OR 3.18 [95% CI, 1.33–5.42]) in group 3. Conclusion TAVR‐related TP is predictable and classification by PTP and TP severity prior to TAVR allows for better risk stratification in predicting in‐hospital clinical outcomes. Major TP in the presence of worsening TP is predictable and is associated with worse clinical outcomes.Keywords
This publication has 14 references indexed in Scilit:
- Incidence and implications of idiopathic thrombocytopenia following transcatheter aortic valve replacement with the Edwards Sapien© valves: A single center experienceCatheterization and Cardiovascular Interventions, 2013
- Effect of Transcatheter (via Femoral Artery) Aortic Valve Implantation on the Platelet Count and Its ConsequencesThe American Journal of Cardiology, 2013
- Two-Year Outcomes after Transcatheter or Surgical Aortic-Valve ReplacementThe New England Journal of Medicine, 2012
- Transcatheter Aortic-Valve Implantation for Aortic Stenosis in Patients Who Cannot Undergo SurgeryThe New England Journal of Medicine, 2010
- Thrombocytopenia After Aortic Valve Replacement With Freedom Solo Bioprosthesis: A Propensity StudyThe Annals of Thoracic Surgery, 2010
- Incidence and Prognostic Significance of Thrombocytopenia Developed During Acute Coronary Syndrome in Contemporary Clinical PracticeCirculation, 2009
- Percutaneous Transarterial Aortic Valve Replacement in Selected High-Risk Patients With Aortic StenosisCirculation, 2007
- Percutaneous Implantation of the CoreValve Self-Expanding Valve Prosthesis in High-Risk Patients With Aortic Valve DiseaseCirculation, 2006
- Impact of body mass index on outcomes after primary angioplasty in acute myocardial infarctionAmerican Heart Journal, 2006
- Acquired von Willebrand Syndrome in Aortic StenosisThe New England Journal of Medicine, 2003