Key result
Persistent major thrombocytopenia occurred in 7.7% of patients after TAVR and was independently associated with increased mortality (HR 3.65; 95% CI 1.63-8.16; P=0.002).
Why the study?
Does balloon-expandable TAVR compared to SAVR affect the incidence and prognostic implications of major thrombocytopenia in patients undergoing aortic valve replacement?
Cohort (n=303)
No
Does balloon-expandable TAVR compared to SAVR affect the incidence and prognostic implications of major thrombocytopenia in patients undergoing aortic valve replacement?
Hazard Ratio: 3.65 (95% CI 1.63–8.16)
p-value: p=0.002
Post-TAVR thrombocytopenia is common and similar in magnitude to post-SAVR, but is mostly transient and benign unless persistent, which is associated with increased mortality.
Persistent post-TAVR thrombocytopenia may warrant closer surveillance; this Level 3 association leaves open causality and requires prospective confirmation.
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.
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Jilaihawi et al. (2014) conducted a cohort in Aortic valve disease requiring replacement (n=303). Major thrombocytopenia post-TAVR vs. No major thrombocytopenia was evaluated on Mortality associated with persistent major thrombocytopenia (HR 3.65, 95% CI 1.63-8.16, p=0.002). Persistent major thrombocytopenia occurred in 7.7% of patients after TAVR and was independently associated with increased mortality (HR 3.65; 95% CI 1.63-8.16; P=0.002).
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