Acquired thrombocytopenia after transcatheter aortic valve replacement: clinical correlates and association with outcomes.

Abstract

AIMS:

This study aimed to evaluate incidence and correlates for low platelet count after transcatheter aortic valve replacement (TAVR) and to determine a possible association between acquired thrombocytopenia and clinical outcomes.

METHODS AND RESULTS:

Patients undergoing TAVR from two medical centres were included in the study. They were stratified according to nadir platelet count post procedure: no/mild thrombocytopenia, ≥100 × 10(9)/L; moderate, 50-99 × 10(9)/L; and severe, <50 × 10(9)/L. A total of 488 patients composed of the study population (age 84.7 ± 7.5 years). At a median time of 2 days after TAVR, 176 patients (36.1%) developed significant thrombocytopenia: 149 (30.5%) moderate; 27 patients (5.5%) severe. Upon discharge, the vast majority of patients (90.2%) had no/mild thrombocytopenia. Nadir platelet count <50 × 10(9)/L was highly specific (96.3%), and a count <150 × 10(9)/L highly sensitive (91.2%), for predicting 30-day death (C-statistic 0.76). Patients with severe acquired thrombocytopenia had a significantly higher mortality rate at 1 year (66.7% for severe vs. 16.0% for no/mild vs. 20.1% for moderate; P < 0.001). In multivariate logistic regression, severe thrombocytopenia was independently associated with 1-year mortality (hazard ratio 3.44, CI: 1.02-11.6; P = 0.046).

CONCLUSIONS:

Acquired thrombocytopenia was common after TAVR and was mostly resolved at patient discharge. The severity of thrombocytopenia after TAVR could be used as an excellent, easily obtainable, marker for worse short- and long-term outcomes after the procedure.

• Authors: Danny Dvir, Philippe Généreux, Israel M Barbash, Susheel Kodali, Itsik Ben-Dor, Mathew Williams, Rebecca Torguson, Ajay J Kirtane, Sa'ar Minha, Salem Badr, Lakshmana K Pendyala, Joshua P Loh, Petros G Okubagzi, Jessica N Fields, Ke Xu, Fang Chen, Rebecca T Hahn, Lowell F Satler, Craig Smith, Augusto D Pichard, Martin B Leon, Ron Waksman
• Journal: European heart journal (Eur Heart J) Vol. 35 Issue 38 Pg. 2663-71 (Oct 07 2014) ISSN: 1522-9645 [Electronic] England
• PMID: 24598983 (Publication Type: Journal Article, Multicenter Study)
• Copyright: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2014. For permissions please email: [email protected].

Topics

• Aged, 80 and over
• Aortic Valve Stenosis (surgery)
• Female
• Humans
• Length of Stay
• Male
• Platelet Count
• Thrombocytopenia (etiology)
• Transcatheter Aortic Valve Replacement (adverse effects)
• Treatment Outcome