Blood Disorders in Patients Undergoing Transcatheter Aortic Valve Replacement

Larochellière, Hugo De; Puri, Rishi; Eikelboom, John W.; Rodés‐Cabau, Josep

doi:10.1016/j.jcin.2018.09.041

Cited by 39 publications

(38 citation statements)

References 58 publications

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“…Furthermore, it is known that bleeding complications and multiple blood transfusions cause pseudothrombocytopenia. 16,18 Therefore, complications should be avoided in patients with thrombocytopenia at baseline.…”

Section: Cause Of Tavi-related Thrombocytopeniamentioning

confidence: 99%

Predictor and Mid-Term Outcome of Clinically Significant Thrombocytopenia After Transcatheter Aortic Valve Selection

Takahashi

Yokoyama

Watanabe

et al. 2020

Circ J

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Background: The frequency and predictors of thrombocytopenia after transcatheter aortic valve implantation (TAVI) are unclear. Methods and Results: This study enrolled 342 patients undergoing TAVI (245 with a percutaneous transfemoral approach, 65 with transfemoral surgical cutdown, and 32 with a non-transfemoral approach). Balloon-expandable and self-expanding valves were implanted in 235 and 107 patients, respectively. Platelet counts started to drop immediately, reaching a nadir 2-4 days after TAVI. Clinically significant thrombocytopenia (CSTP) was defined as a platelet count ≤50×10 9 /L at the time of the nadir or both a platelet count between 80 and 51×10 9 /L and a decrease in platelet count ≥50%. CSTP occurred in 16.7% patients. Approach site and TAVI valve selection significantly predicted CSTP. In multivariate analysis, independent predictors of CSTP were liver cirrhosis (odds ratio [OR] 7.22; 95% confidence interval [CI] 1.05-49.82), baseline platelet count ≤120×10 9 /L (OR 2.98; 95% CI 1.20-7.38), multiple blood transfusions (OR 4.03; 95% CI 1.72-9.41), and the use of balloon-expandable valves (OR 2.38; 95% CI 1.04-5.46). Kaplan-Meier survival analysis with a generalized Wilcoxon test revealed that mid-term (2 years) mortality was greater for patients with than without CSTP (31.4% vs. 15.5%; P=0.008). Conclusions: TAVI-related CSTP was not rare and was associated with poor mid-term outcomes. CSTP was not only caused by patients' comorbidities and TAVI complications, but also related to TAVI procedural factors.

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Section: Cause Of Tavi-related Thrombocytopeniamentioning

confidence: 99%

Predictor and Mid-Term Outcome of Clinically Significant Thrombocytopenia After Transcatheter Aortic Valve Selection

Takahashi

Yokoyama

Watanabe

et al. 2020

Circ J

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“…[59][60][61][62][63][64] Finally, a periprocedural thrombo-inflammatory state and reduced platelet turnover in the older patient may act synergistically, resulting in transient thrombocytopenia in 69-87% of TAVI patients, signalling severe impairment of general homeostasis. [65][66][67] Gastrointestinal bleeding associated with aortic stenosis is due to the shear stress and flow turbulence across the stenotic aortic valve, which may cause the cleavage of high-molecular-weight multimers of von Willebrand factor, a coagulation protein responsible for haemostasis.…”

Section: Bleeding Eventsmentioning

confidence: 99%

Anticoagulation after Transcatheter Aortic Valve Implantation: Current Status

Greco

Capodanno

2020

Interv Cardiol

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Transcatheter aortic valve implantation (TAVI) is the standard of care for symptomatic severe aortic stenosis. Antithrombotic therapy is required after TAVI to prevent thrombotic complications but it increases the risk of bleeding events. Current clinical guidelines are mostly driven by expert opinion and therefore yield low-grade recommendations. The optimal antithrombotic regimen following TAVI has yet to be determined and several randomised controlled trials assessing this issue are ongoing. The purpose of this article is to critically explore the impact of antithrombotic drugs, especially anticoagulants, on long-term clinical outcomes following successful TAVI.

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“…TAVR 21. The present study aimed to assess the clinical importance of CTP in patients undergoing TAVR utilizing robust propensity score matching methodology to account for important covariates confounding CTP in a national cohort.…”

mentioning

confidence: 99%

Impact of chronic thrombocytopenia on in‐hospital outcomes and healthcare resource utilization after transcatheter aortic valve replacement

Fugar

Behnamfar

Okoh

et al. 2019

Cathet Cardio Intervent

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Background: There is little data on the impact of chronic thrombocytopenia (CTP) on outcomes after transcatheter aortic valve repair (TAVR). Most studies are from single centers and mostly focused on postprocedure thrombocytopenia. Objectives: This study sought to report on the impact of CTP (>1 year) on in-hospital outcomes and healthcare resource utilization after TAVR. Methods: From the National Inpatient Sample (NIS) between 2012 and 2015, we identified patients with CTP who underwent TAVR. A 1:1 propensity-matched cohort was created to examine in-hospital outcomes in patients with and without CTP. The primary outcome was in-hospital mortality. Secondary outcomes included postprocedure complications, length of stay, total cost, and discharge disposition. Results: A matched pair of 4,300 patients with and without CTP were identified. Patients with CTP had higher in-hospital mortality as compared to no CTP patients (6.0 vs. 3.3%, p-value .007), increased postprocedure hemorrhage, platelet and blood transfusion, vascular complications, postop sepsis, and acute kidney injury. With regards to resource utilization, CTP patients had a longer length of stay, higher total cost and were more likely to be discharged to a facility (34.1 vs. 27.6%) other than home (All, p-value <.001). Subanalysis, however, revealed this difference in resource utilization was seen when patients developed postprocedure complications. Conclusion: This study demonstrated higher risk of in-hospital mortality, perioperative complications, and healthcare resource utilization in patients with baseline CTP undergoing TAVR. Further studies are required to investigate ways to improve the management of these patients.

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Blood Disorders in Patients Undergoing Transcatheter Aortic Valve Replacement

Cited by 39 publications

References 58 publications

Predictor and Mid-Term Outcome of Clinically Significant Thrombocytopenia After Transcatheter Aortic Valve Selection

Predictor and Mid-Term Outcome of Clinically Significant Thrombocytopenia After Transcatheter Aortic Valve Selection

Anticoagulation after Transcatheter Aortic Valve Implantation: Current Status

Impact of chronic thrombocytopenia on in‐hospital outcomes and healthcare resource utilization after transcatheter aortic valve replacement

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