Acquired thrombocytopenia after transcatheter aortic valve replacement: clinical correlates and association with outcomes
Key result
Severe acquired thrombocytopenia after TAVR linked to ~244% higher one-year mortality.
- HR 3.44
- 95% CI 1.02-11.6
- P=0.046
- n=488
Why the study?
This study aimed to evaluate the incidence and correlates of low platelet count after TAVR and determine its association with clinical outcomes.
Does acquired thrombocytopenia after TAVR predict increased mortality in patients undergoing the procedure?
Key Points
- This study aimed to evaluate the incidence of thrombocytopenia after TAVR and its association with clinical outcomes.
- Included 488 patients undergoing TAVR from two medical centers.
- Patients were stratified by nadir platelet count post-procedure into no/mild, moderate, and severe thrombocytopenia.
- Results were analyzed through multivariate logistic regression.
- 36.1% of patients developed significant thrombocytopenia, with 30.5% moderate and 5.5% severe cases.
- Severe thrombocytopenia was associated with a 1-year mortality rate of 66.7% compared to 16.0% for no/mild and 20.1% for moderate; P < 0.001.
- Severe thrombocytopenia had a hazard ratio of 3.44 for 1-year mortality, indicating more than three times the risk.
Study Design
Type
Cohort (n=488)
Multicenter
Yes
Structured PICO
Does acquired thrombocytopenia after TAVR predict increased mortality in patients undergoing the procedure?
P
Population
488 patients undergoing transcatheter aortic valve replacement (TAVR) from two medical centres, mean age 84.7 ± 7.5 years.
I
Intervention
Severe acquired thrombocytopenia (nadir platelet count <50 × 10^9/L) or moderate acquired thrombocytopenia (50-99 × 10^9/L) after TAVR
C
Comparator
No/mild thrombocytopenia (nadir platelet count ≥100 × 10^9/L) after TAVR
O
Outcome
30-day death and 1-year mortalityhard clinical
Main Result
Effect estimate: HR 3.44 (95% CI 1.02-11.6)
Absolute Event Rate: 66.7% vs 16%
p-value: p=0.046
Severe acquired thrombocytopenia after TAVR is a common and easily obtainable marker that independently predicts worse short- and long-term mortality.
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“Rather than being directly implicated in the causal pathway to death, platelet count could be viewed as a 'final common pathway' of several death correlates, being an easily obtainable lab result with high predictability, similar to the way in which systemic inflammatory response after TAVR is strongly associated with outcome.”
Implication
Post-TAVR thrombocytopenia was associated with adverse outcomes; leaves open causality and need for prospective trials.
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.
Discussion
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Cite This Study
Dvir et al. (2014) conducted a cohort in Transcatheter aortic valve replacement (TAVR) (n=488). Severe acquired thrombocytopenia (<50 × 10(9)/L) vs. No/mild thrombocytopenia (≥100 × 10(9)/L) was evaluated on 1-year mortality (HR 3.44, 95% CI 1.02-11.6, p=0.046). Severe acquired thrombocytopenia after TAVR was independently associated with higher 1-year mortality compared to no/mild thrombocytopenia (66.7% vs 16.0%; HR 3.44, 95% CI 1.02-11.6, P=0.046).