Preprocedural P2Y12 inhibition and decrease in platelet count following transcatheter aortic valve replacement

Abstract Background Thrombocytopenia after transcatheter aortic valve replacement (TAVR) is associated with adverse clinical outcomes. Whether preprocedural P2Y 12 inhibition prevents postprocedural thrombocytopenia is uncertain. Methods This retrospective analysis identified consecutive patients ( n = 266) undergoing TAVR between November 2016 and July 2017. Preprocedure clopidogrel load ≥300 mg or maintenance P2Y 12 inhibitor therapy defined preprocedural P2Y 12 inhibition. Patients who did not consent for the registry ( n = 8), with baseline severe thrombocytopenia (20% decrease in platelet count from baseline to day 1 post‐TAVR. Results Patients with ( n = 134) versus without ( n = 106) preprocedural P2Y 12 inhibition had no differences in platelet count at baseline. Patients with preprocedural P2Y 12 inhibition had a significantly lower proportion of the primary outcome (34.3% vs. 57.5%, p = .001) and a lower absolute decrease in platelet count (32.8 × 10 3 vs. 45.8 × 10 3 platelet/μL, p = .01). Of patients without baseline thrombocytopenia ( n = 198), a numerically lower rate of patients with versus without preprocedural P2Y 12 inhibition developed thrombocytopenia on day 1 post‐TAVR (25.5% vs. 36.4%, p = .1). Conclusion Patients who received preprocedural P2Y 12 inhibition prior to TAVR were less likely to demonstrate a decrease in platelet count after TAVR. Prospective studies to further understand the clinical implication of these findings are warranted.