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Major thrombocytopenia after balloon‐expandable transcatheter aortic valve replacement: Prognostic implications and comparison to surgical aortic valve replacement
Author(s) -
Jilaihawi Hasan,
Doctor Niraj,
Chakravarty Tarun,
Kashif Mohammad,
Mirocha James,
Cheng Wen,
Lill Michael,
Nakamura Mamoo,
Gheorghiu Mitch,
Makkar Raj R.
Publication year - 2014
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.25430
Subject(s) - medicine , valve replacement , cardiology , aortic valve replacement , aortic valve , balloon , stroke (engine) , surgery , population , stenosis , mechanical engineering , engineering , environmental health
Objectives We sought to investigate the magnitude and clinical importance of thrombocytopenia post transcatheter aortic valve replacement (TAVR). Background Thrombocytopenia has been observed after TAVR but has not been well studied. Methods Major thrombocytopenia (platelet count <100 × 10 9 /L) was studied following aortic valve interventions in a single center. Changes in platelets were compared in 246 patients undergoing balloon‐expandable TAVR and a similar population of 57 cases undergoing surgical aortic valve replacement (SAVR in the US PARTNER IA trial). Results An early drop in platelets was seen on the day of intervention. The drop day 1 post procedure was similar but slightly greater with SAVR vs. TAVR. In both platelet counts continued to drop, reaching a nadir of approximately 50–60% of the baseline platelet count at day 2–3, starting to recover after day 5. Early major thrombocytopenia occurred post TAVR in 37% of patients but was not significantly related to major bleeding (OR 0.89, 95% CI 0.51–1.60, P = 0.69) or risk of stroke (HR 0.61, 95% CI 0.16–2.20, P = 0.45); there was a trend to greater acute kidney injury (OR 1.76, 95% CI 0.95–3.26, P = 0.073) and mortality (HR 1.47, 95% CI 0.98–2.22, P = 0.065). Major thrombocytopenia was persistent in 7.7% of patients and this was independently associated with mortality (HR 3.65, 95% CI 1.63–8.16, P = 0.002). Conclusions Post‐TAVR thrombocytopenia is a common phenomenon and its magnitude appears similar to that seen after SAVR. It is most often transient, not associated with adverse sequelae and, unless persistent, should be managed in an expectant fashion. © 2014 Wiley Periodicals, Inc.