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

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
DOI: http://dx.doi.org/10.1093/eurheartj/ehu082 2663-2671 First published online: 5 March 2014

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 × 109/L; moderate, 50–99 × 109/L; and severe, <50 × 109/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 × 109/L was highly specific (96.3%), and a count <150 × 109/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.

  • Transcatheter aortic valve replacement
  • Thrombocytopenia
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