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

Fugar, Setri; Behnamfar, Omid; Okoh, Alexis K.; Alabre, Alisha F.; Salia, Soziema; Kosinski, Mark; Ali, Mahmood; Jolly, Neeraj; Doukky, Rami; Kavinsky, Clifford J.

doi:10.1002/ccd.28519

Cited by 5 publications

(8 citation statements)

References 23 publications

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“…Thrombocytopenia has been studied in various cardiovascular procedures and is associated with a higher incidence of adverse outcomes, increased mortality rate, and higher health care costs [5,6]. Patients with ITP who undergo cardiac surgery with extracorporeal circulation have an increased risk of postoperative bleeding, postoperative infection, acute kidney injury, and mortality [7][8][9].…”

Section: Discussionmentioning

confidence: 99%

Initial Thrombocyte Concentrate Transfusion in Woman with Chronic Immune Thrombocytopenia Purpura (ITP) Who Underwent Mitral Valve Replacement Surgery: A Case Report

et al. 2023

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Rare coexistence of disease or pathology Background:Chronic immune thrombocytopenia purpura (ITP) is associated with a higher incidence of adverse outcomes, increased morbidity and mortality rates, and higher health care costs, especially in open-heart surgery. The information regarding managing chronic ITP in patients undergoing mitral valve replacement (MVR) surgery is scarce, and reported cases are limited. Case Report:A 42-year-old woman with more than 20 years of history of immune thrombocytopenia purpura (ITP) had episodes of breathing difficulties in the last 4 years. The patient was diagnosed with severe mitral stenosis (MS) and moderate mitral regurgitation (MR). Laboratory examination before surgery showed thrombocytopenia (49 000/µL). Therefore, the surgery was postponed until the platelet count exceeded 100 000/µL. The patient was given 10 units of thrombocyte concentrate 1 day before surgery and 500 mg of methylprednisolone 3 times a day orally for 5 days as preoperative management. Under a total cardiopulmonary bypass, MVR was performed using a bioprosthetic valve. Postoperative transthoracic echocardiography (TTE) showed no valvular leakage in the surrounding of the prosthetic valve and that the valve was functioning normally. Platelet monitoring was conducted, and the platelet count increased to 147 000/µL on the third day. Conclusions:Our case report shows that aggressive preoperative platelet count correction and treatment may lower the risk associated with a low and unstable platelet count and reduce the risk of mortality and morbidity in patients with ITP who undergo MVR procedures.

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Section: Discussionmentioning

confidence: 99%

Initial Thrombocyte Concentrate Transfusion in Woman with Chronic Immune Thrombocytopenia Purpura (ITP) Who Underwent Mitral Valve Replacement Surgery: A Case Report

et al. 2023

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“…Studies have conflicting results with regards to post-TAVR short- and long-term mortality associated with chronic thrombocytopenia. A propensity-matched cohort from the National Inpatient Sample (NIS) from 2012–2015 showed increased in-hospital mortality in patients with chronic thrombocytopenia (6.0% versus 3.3%, p value 0.007) [ 18 ]. However, another propensity-matched analysis of the NIS up to 2014 showed no difference in in-hospital mortality (4.5% versus 5.7%; adjusted odds ratio [adjOR] 0.79; 95% CI 0.57–1.09; p = 0.16) [ 19 ].…”

Section: Systemic and Patient-related Factorsmentioning

confidence: 99%

Transcatheter Aortic Valve Replacement in Special Populations

Ahmad¹,

Mentias²,

Imran³

et al. 2023

Rev. Cardiovasc. Med.

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Since its food and drug administration (FDA) approval in 2011, transcatheter aortic valve replacement (TAVR) has revolutionized the highly prevalent disease of aortic stenosis. In this review, we present a comprehensive overview of the data and considerations for utilization of TAVR in special populations who were either excluded from or not adequately represented in the seminal TAVR trials, due to high-risk valvular and/or systemic factors. These include nonagenarians, patients with renal dysfunction, chronic thrombocytopenia, bicuspid aortic valve, rheumatic valve disease, patients with failed aortic valve bioprosthesis requiring valve-in-valve intervention and patients with mixed aortic valve disease. In short, TAVR is a feasible therapeutic strategy in high-risk and special populations with mortality benefit and improvement in quality of life. Randomized controlled trials in high-risk populations are recommended to confirm results from observational studies.

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“…Thrombocytopenia is reported at baseline in 20-40% of the patient undergoing TAVR [ 68 , 69 ]. Fugar et al [ 70 ] conducted a meta-analysis of 60990 cases of TAVR using the NIS database. With the exclusion of peri-procedural thrombocytopenia, 4300 patients (7.3%) were found to have chronic thrombocytopenia (CTP).…”

Section: Reviewmentioning

confidence: 99%

“…Similar results were reported in a retrospective study of 732 subjects undergoing TAVR with severe symptomatic AS [ 68 ]. CTP was found to be an independent risk factor for 30-day (HR: 13.18, 95% CI: 4.49-38.64, p<0.001) and one-year all-cause mortality (HR: 5.90, 95% CI: 2.68-13.02, p<0.001) [ 70 ].…”

Section: Reviewmentioning

confidence: 99%

The Role of Transcatheter Aortic Valve Replacement in Asymptomatic Aortic Stenosis: A Feasibility Analysis

Rasool¹,

Saleem²,

Nadeem³

et al. 2022

Cureus

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Surgical aortic valve replacement (SAVR) is the current treatment of choice for good surgical candidates with moderate to severe symptomatic aortic stenosis (AS). As transcatheter aortic valvular replacement (TAVR) has shown an improved one and two-year all-cause mortality, it has been chosen for moderately symptomatic severe AS patients. The purpose of this review was to perform a clinical comparison of TAVR vs. SAVR and to analyze the Health Index Factor (HIF) that makes TAVR a treatment of choice in asymptomatic AS patients.An extensive literature search of PubMed, Cochrane, and Embase databases was performed using the keywords "Aortic stenosis", "SAVR", "TAVR", and "Asymptomatic". A total of 45 prospective randomized clinical trials in the English language that were published from the year 2000 onwards were included in the final analysis. It has been found that 59.3% of asymptomatic AS patients are likely to die in the next five years without proactive treatment. Multiple studies have proven that early intervention with aortic valve replacement is superior to conservative treatment in severe asymptomatic AS; however, the choice between SAVR and TAVR is not well established. The NOTION Trial, SURTAVI Trail, and PARTNER 3 study have shown the non-inferiority of TAVR over SAVR, during one-year follow-up for low surgical risk patients. Evolut Low-Risk study and Early TAVR are the only two prospective studies performed to date that have enrolled patients with asymptomatic severe AS. The Evolut Trial demonstrated no difference in all-cause mortality at 30 days (1.3% vs. 4.8%. p=0.23), and 12 days (1.3% vs. 6.5%, p=0.11). Additionally, TAVR also decreases the risk of post-procedural atrial fibrillation, acute kidney injury (AKI), and rehospitalization, and leads to significant improvement in the mean trans-aortic pressure gradient. TAVR also showed marked improvement in the 30-day Quality of Life (QOL) index, where SAVR did not report any significant change in the QOL index. However, the official recommendations of Early TAVR are still awaited. TAVR has consistently shown a statistically non-significant difference in case mortality, risk of stroke, and rehospitalization with moderate to high surgical risk patients whereby recent initial trials have shown significant improvement in the QOL index and hemodynamic index for patients with asymptomatic disease. More extensive studies are required to prove the risk stratifications, long-term outcomes, and clinical characteristics that would make TAVR a preferred intervention in asymptomatic patients.

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

Cited by 5 publications

References 23 publications

Initial Thrombocyte Concentrate Transfusion in Woman with Chronic Immune Thrombocytopenia Purpura (ITP) Who Underwent Mitral Valve Replacement Surgery: A Case Report

Initial Thrombocyte Concentrate Transfusion in Woman with Chronic Immune Thrombocytopenia Purpura (ITP) Who Underwent Mitral Valve Replacement Surgery: A Case Report

Transcatheter Aortic Valve Replacement in Special Populations

The Role of Transcatheter Aortic Valve Replacement in Asymptomatic Aortic Stenosis: A Feasibility Analysis

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