Acquired thrombocytopenia after transcatheter aortic valve replacement

Clinical correlates and association with outcomes

Danny Dvir, Philippe Genereux, 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 & 2 others Martin B. Leon, Ron Waksman

Research output: Contribution to journalArticle

30 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)2663-2671
Number of pages9
JournalEuropean Heart Journal
Volume35
Issue number38
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Thrombocytopenia
Platelet Count
Mortality
Transcatheter Aortic Valve Replacement
Patient Discharge
Logistic Models
Incidence
Population

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Dvir, Danny ; Genereux, Philippe ; Barbash, Israel M. ; Kodali, Susheel ; Ben-Dor, Itsik ; Williams, Mathew ; Torguson, Rebecca ; Kirtane, Ajay J. ; Minha, Sa'ar ; Badr, Salem ; Pendyala, Lakshmana K. ; Loh, Joshua P. ; Okubagzi, Petros G. ; Fields, Jessica N. ; Xu, Ke ; Chen, Fang ; Hahn, Rebecca T. ; Satler, Lowell F. ; Smith, Craig ; Pichard, Augusto D. ; Leon, Martin B. ; Waksman, Ron. / Acquired thrombocytopenia after transcatheter aortic valve replacement : Clinical correlates and association with outcomes. In: European Heart Journal. 2014 ; Vol. 35, No. 38. pp. 2663-2671.
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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.",
author = "Danny Dvir and Philippe Genereux and Barbash, {Israel M.} and Susheel Kodali and Itsik Ben-Dor and Mathew Williams and Rebecca Torguson and Kirtane, {Ajay J.} and Sa'ar Minha and Salem Badr and Pendyala, {Lakshmana K.} and Loh, {Joshua P.} and Okubagzi, {Petros G.} and Fields, {Jessica N.} and Ke Xu and Fang Chen and Hahn, {Rebecca T.} and Satler, {Lowell F.} and Craig Smith and Pichard, {Augusto D.} and Leon, {Martin B.} and Ron Waksman",
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Dvir, D, Genereux, P, Barbash, IM, Kodali, S, Ben-Dor, I, Williams, M, Torguson, R, Kirtane, AJ, Minha, S, Badr, S, Pendyala, LK, Loh, JP, Okubagzi, PG, Fields, JN, Xu, K, Chen, F, Hahn, RT, Satler, LF, Smith, C, Pichard, AD, Leon, MB & Waksman, R 2014, 'Acquired thrombocytopenia after transcatheter aortic valve replacement: Clinical correlates and association with outcomes', European Heart Journal, vol. 35, no. 38, pp. 2663-2671. https://doi.org/10.1093/eurheartj/ehu082

Acquired thrombocytopenia after transcatheter aortic valve replacement : Clinical correlates and association with outcomes. / Dvir, Danny; Genereux, Philippe; Barbash, Israel M.; Kodali, Susheel; Ben-Dor, Itsik; Williams, Mathew; Torguson, Rebecca; Kirtane, Ajay J.; Minha, Sa'ar; Badr, Salem; Pendyala, Lakshmana K.; Loh, Joshua P.; Okubagzi, Petros G.; Fields, Jessica N.; Xu, Ke; Chen, Fang; Hahn, Rebecca T.; Satler, Lowell F.; Smith, Craig; Pichard, Augusto D.; Leon, Martin B.; Waksman, Ron.

In: European Heart Journal, Vol. 35, No. 38, 01.01.2014, p. 2663-2671.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Acquired thrombocytopenia after transcatheter aortic valve replacement

T2 - Clinical correlates and association with outcomes

AU - Dvir, Danny

AU - Genereux, Philippe

AU - Barbash, Israel M.

AU - Kodali, Susheel

AU - Ben-Dor, Itsik

AU - Williams, Mathew

AU - Torguson, Rebecca

AU - Kirtane, Ajay J.

AU - Minha, Sa'ar

AU - Badr, Salem

AU - Pendyala, Lakshmana K.

AU - Loh, Joshua P.

AU - Okubagzi, Petros G.

AU - Fields, Jessica N.

AU - Xu, Ke

AU - Chen, Fang

AU - Hahn, Rebecca T.

AU - Satler, Lowell F.

AU - Smith, Craig

AU - Pichard, Augusto D.

AU - Leon, Martin B.

AU - Waksman, Ron

PY - 2014/1/1

Y1 - 2014/1/1

N2 - 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.

AB - 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.

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U2 - 10.1093/eurheartj/ehu082

DO - 10.1093/eurheartj/ehu082

M3 - Article

VL - 35

SP - 2663

EP - 2671

JO - European Heart Journal

JF - European Heart Journal

SN - 0195-668X

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