Trends in Transfemoral Aortic Valve Implantation Related Thrombocytopenia

Abstract

Background: TAVI related thrombocytopenia (TAVI-rTP) is still very common. The aim of this study was to compare the incidence, characteristics and impact of reduced platelet counts (RPC) after TAVI between an earlier and contemporary period. Methods: the patients enrolled were those experiencing severe symptomatic aortic stenosis who underwent TAVI between January 2010 and December 2019. The exclusion criteria were no available blood tests and periprocedural death. Results: 334 patients (mean age 81.9 ± 6.7 years) were enrolled. For the earlier period, the mean RPC was 33 ± 15%, and in the contemporary period (2016–2019) it was 26 ± 14%. In the early group, we found that 62% of the patients had decreased platelet counts of more or equal to 30% in comparison to 33% in the contemporary period. The time of the procedure and the amount of the contrast that had been used in the later period were associated with significant RPCs (p value = 0.002 and 0.028, respectively). An RPC of 30% or more was associated with the increased risks of life-threatening bleeding, vascular complications and death within 30 days. Conclusion: contemporary TAVI-rTP continued to be a common phenomenon in our cohort. However, severe thrombocytopenia was significantly less frequent. An RPC of 30% or more is associated with a poor 30-day outcome.

Acquired Thrombocytopenia in Contemporary Transcatheter Aortic Valve Prosthesis

“…Improvement in prosthesis design, delivery systems, and possibly standardization and training in implantation procedures have led to an improvement in this condition. 6 However, the reason for platelet decline remains not fully understood and speculative. 11,15 Preoperative use of platelet aggregation inhibitors and oral anticoagulation may contribute to postprocedural platelet kinetics.…”

“…DPCs were calculated using the maximum postprocedural hematocrit-corrected platelet drop (at nadir) as a fraction of the baseline platelet count (in percent) according to the definition in previous studies. 6,7,14 Thrombocytopenia was defined as a corrected platelet count lower than 150 Â 10 9 /L and stratified as mild (100 to 149 Â 10 9 /L), moderate (50 to 99 Â 10 9 /L), and severe (under 50 Â 10 9 /L).…”

“…The absolute difference between the preoperative platelet count and the nadir count was calculated as a maximal platelet drop. Drop platelet counts (DPC) were calculated using the maximum postprocedural hematocrit-corrected platelet drop (at nadir) as a fraction of the baseline platelet count (in percent) according to the definition in previous studies 6,7,14 .…”

“…Since its initial systematic description by Gallet et al in 2013, further studies have observed a drop in platelets in the majority of patients postprocedurally. [5][6][7][8] An association with inferior outcomes and more frequent complications has also been reported. 7,9 That is why, further research as to the cause of this condition and its prevention is warranted.…”

“…Postprocedural TAVI related thrombocytopenia (TAVI-rTP) is a common phenomenon. Since its initial systematic description by Gallet et al in 2013 further studies have observed a drop in platelets in the majority of patients postprocedurally [5][6][7][8] .…”