Thrombocytopenia after transcatheter aortic valve implantation

Gabriela Tirado-Conte; Vassili Panagides; Carlos E Vergara-Uzcategui; Gabriela Veiga Fernández; Jean Paul Vílchez; Pedro Cepas-Guillén; Juan Francisco Oteo; Alejandro Barrero; Luis Marroquín; Julio I Farjat-Pasos; Ketina Arslani; Pilar Jiménez-Quevedo; Iván Núñez-Gil; Hernán Mejía-Rentería; José M de la Torre Hernández; José Luis Díez Gil; Ander Regueiro; Ignacio Amat-Santos; Antonio Fernández-Ortiz; Guering Eid-Lidt; Ole De Backer; Josep Rodés-Cabau; Luis Nombela-Franco

doi:10.1016/j.rec.2024.08.003

Thrombocytopenia after transcatheter aortic valve implantation

Gabriela Tirado-Conte, Vassili Panagides, Carlos E Vergara-Uzcategui, Gabriela Veiga Fernández, Jean Paul Vílchez, Pedro Cepas-Guillén, Juan Francisco Oteo, Alejandro Barrero, Luis Marroquín, Julio I Farjat-Pasos, Ketina Arslani, Pilar Jiménez-Quevedo, Iván Núñez-Gil, Hernán Mejía-Rentería, José M de la Torre Hernández, José Luis Díez Gil, Ander Regueiro, Ignacio Amat-Santos, Antonio Fernández-Ortiz, Guering Eid-LidtOle De Backer, Josep Rodés-Cabau, Luis Nombela-Franco^*

^*Corresponding author af dette arbejde

Afdeling for Hjertesygdomme

Abstract

INTRODUCTION AND OBJECTIVES: Thrombocytopenia frequently occurs after transcatheter aortic valve implantation (TAVI) but its impact is poorly understood. We aimed to analyze the incidence, clinical impact, and predictors of acquired thrombocytopenia after TAVI.

METHODS: This retrospective multicenter registry included 3913 patients undergoing TAVI with a baseline platelet count of ≥ 100 *109/L. Acquired thrombocytopenia was defined as a decrease in baseline platelet count of ≥ 50% (early nadir ≤ 3 days and late nadir ≥ 4 days) post-TAVI. The primary endpoint was 30-day all-cause mortality and secondary endpoints were procedural safety and 2-year all-cause mortality.

RESULTS: The incidence of acquired thrombocytopenia was 14.8% (early nadir: 61.5%, late nadir: 38.5%). Thirty-day mortality occurred in 112 (3.0%) patients and was significantly higher in those with thrombocytopenia (8.5% vs 2.0%, adjusted OR, 2.3; 95%CI, 1.3-4.2). Procedural safety was lower and 2-year mortality was higher in patients with thrombocytopenia vs those without (52.1 vs 77.0%; P <.001, and 30.2% vs 16.8%; HR, 2.2, 95%IC, 1.3-2.7) and especially in those with late nadir thrombocytopenia (45.8% vs 54.5%; P=.056, and 38.6% vs 23.8%, HR, 2.1; 95%CI, 1.5-2.9). Independent predictors of thrombocytopenia comprised baseline and procedural factors such as body surface area, absence of diabetes, poorer renal function, peripheral vascular disease, nontransfemoral access, vascular complications, type of transcatheter heart valve, and earlier TAVI procedures.

CONCLUSIONS: Acquired thrombocytopenia was common (15%) after TAVI and was associated with increased short- and mid-term mortality and decreased procedural safety. Moreover, late thrombocytopenia compared with early thrombocytopenia was associated with significantly worse clinical outcomes. Further investigations are needed to elucidate the etiologic mechanisms behind these findings.

Originalsprog	Engelsk
Tidsskrift	Revista espanola de cardiologia (English ed.)
ISSN	1885-5857
DOI	https://doi.org/10.1016/j.rec.2024.08.003
Status	E-pub ahead of print - 7 sep. 2024

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10.1016/j.rec.2024.08.003

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Tirado-Conte, G., Panagides, V., Vergara-Uzcategui, C. E., Fernández, G. V., Vílchez, J. P., Cepas-Guillén, P., Oteo, J. F., Barrero, A., Marroquín, L., Farjat-Pasos, J. I., Arslani, K., Jiménez-Quevedo, P., Núñez-Gil, I., Mejía-Rentería, H., de la Torre Hernández, J. M., Luis Díez Gil, J., Regueiro, A., Amat-Santos, I., Fernández-Ortiz, A., ... Nombela-Franco, L. (2024). Thrombocytopenia after transcatheter aortic valve implantation. Revista espanola de cardiologia (English ed.). Advance online publication. https://doi.org/10.1016/j.rec.2024.08.003

Tirado-Conte, G, Panagides, V, Vergara-Uzcategui, CE, Fernández, GV, Vílchez, JP, Cepas-Guillén, P, Oteo, JF, Barrero, A, Marroquín, L, Farjat-Pasos, JI, Arslani, K, Jiménez-Quevedo, P, Núñez-Gil, I, Mejía-Rentería, H, de la Torre Hernández, JM, Luis Díez Gil, J, Regueiro, A, Amat-Santos, I, Fernández-Ortiz, A, Eid-Lidt, G, Backer, OD, Rodés-Cabau, J & Nombela-Franco, L 2024, 'Thrombocytopenia after transcatheter aortic valve implantation', Revista espanola de cardiologia (English ed.). https://doi.org/10.1016/j.rec.2024.08.003

@article{b033811719f540f29dac08bcf35afa21,

title = "Thrombocytopenia after transcatheter aortic valve implantation",

abstract = "INTRODUCTION AND OBJECTIVES: Thrombocytopenia frequently occurs after transcatheter aortic valve implantation (TAVI) but its impact is poorly understood. We aimed to analyze the incidence, clinical impact, and predictors of acquired thrombocytopenia after TAVI.METHODS: This retrospective multicenter registry included 3913 patients undergoing TAVI with a baseline platelet count of ≥ 100 *109/L. Acquired thrombocytopenia was defined as a decrease in baseline platelet count of ≥ 50% (early nadir ≤ 3 days and late nadir ≥ 4 days) post-TAVI. The primary endpoint was 30-day all-cause mortality and secondary endpoints were procedural safety and 2-year all-cause mortality.RESULTS: The incidence of acquired thrombocytopenia was 14.8% (early nadir: 61.5%, late nadir: 38.5%). Thirty-day mortality occurred in 112 (3.0%) patients and was significantly higher in those with thrombocytopenia (8.5% vs 2.0%, adjusted OR, 2.3; 95%CI, 1.3-4.2). Procedural safety was lower and 2-year mortality was higher in patients with thrombocytopenia vs those without (52.1 vs 77.0%; P <.001, and 30.2% vs 16.8%; HR, 2.2, 95%IC, 1.3-2.7) and especially in those with late nadir thrombocytopenia (45.8% vs 54.5%; P=.056, and 38.6% vs 23.8%, HR, 2.1; 95%CI, 1.5-2.9). Independent predictors of thrombocytopenia comprised baseline and procedural factors such as body surface area, absence of diabetes, poorer renal function, peripheral vascular disease, nontransfemoral access, vascular complications, type of transcatheter heart valve, and earlier TAVI procedures.CONCLUSIONS: Acquired thrombocytopenia was common (15%) after TAVI and was associated with increased short- and mid-term mortality and decreased procedural safety. Moreover, late thrombocytopenia compared with early thrombocytopenia was associated with significantly worse clinical outcomes. Further investigations are needed to elucidate the etiologic mechanisms behind these findings.",

author = "Gabriela Tirado-Conte and Vassili Panagides and Vergara-Uzcategui, {Carlos E} and Fern{\'a}ndez, {Gabriela Veiga} and V{\'i}lchez, {Jean Paul} and Pedro Cepas-Guill{\'e}n and Oteo, {Juan Francisco} and Alejandro Barrero and Luis Marroqu{\'i}n and Farjat-Pasos, {Julio I} and Ketina Arslani and Pilar Jim{\'e}nez-Quevedo and Iv{\'a}n N{\'u}{\~n}ez-Gil and Hern{\'a}n Mej{\'i}a-Renter{\'i}a and {de la Torre Hern{\'a}ndez}, {Jos{\'e} M} and {Luis D{\'i}ez Gil}, Jos{\'e} and Ander Regueiro and Ignacio Amat-Santos and Antonio Fern{\'a}ndez-Ortiz and Guering Eid-Lidt and Backer, {Ole De} and Josep Rod{\'e}s-Cabau and Luis Nombela-Franco",

note = "Copyright {\textcopyright} 2024. Published by Elsevier Espa{\~n}a, S.L.U.",

year = "2024",

month = sep,

day = "7",

doi = "10.1016/j.rec.2024.08.003",

language = "English",

journal = "Revista espanola de cardiologia (English ed.)",

issn = "1885-5857",

publisher = "Elsevier Doyma",

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TY - JOUR

T1 - Thrombocytopenia after transcatheter aortic valve implantation

AU - Tirado-Conte, Gabriela

AU - Panagides, Vassili

AU - Vergara-Uzcategui, Carlos E

AU - Fernández, Gabriela Veiga

AU - Vílchez, Jean Paul

AU - Cepas-Guillén, Pedro

AU - Oteo, Juan Francisco

AU - Barrero, Alejandro

AU - Marroquín, Luis

AU - Farjat-Pasos, Julio I

AU - Arslani, Ketina

AU - Jiménez-Quevedo, Pilar

AU - Núñez-Gil, Iván

AU - Mejía-Rentería, Hernán

AU - de la Torre Hernández, José M

AU - Luis Díez Gil, José

AU - Regueiro, Ander

AU - Amat-Santos, Ignacio

AU - Fernández-Ortiz, Antonio

AU - Eid-Lidt, Guering

AU - Backer, Ole De

AU - Rodés-Cabau, Josep

AU - Nombela-Franco, Luis

PY - 2024/9/7

Y1 - 2024/9/7

N2 - INTRODUCTION AND OBJECTIVES: Thrombocytopenia frequently occurs after transcatheter aortic valve implantation (TAVI) but its impact is poorly understood. We aimed to analyze the incidence, clinical impact, and predictors of acquired thrombocytopenia after TAVI.METHODS: This retrospective multicenter registry included 3913 patients undergoing TAVI with a baseline platelet count of ≥ 100 *109/L. Acquired thrombocytopenia was defined as a decrease in baseline platelet count of ≥ 50% (early nadir ≤ 3 days and late nadir ≥ 4 days) post-TAVI. The primary endpoint was 30-day all-cause mortality and secondary endpoints were procedural safety and 2-year all-cause mortality.RESULTS: The incidence of acquired thrombocytopenia was 14.8% (early nadir: 61.5%, late nadir: 38.5%). Thirty-day mortality occurred in 112 (3.0%) patients and was significantly higher in those with thrombocytopenia (8.5% vs 2.0%, adjusted OR, 2.3; 95%CI, 1.3-4.2). Procedural safety was lower and 2-year mortality was higher in patients with thrombocytopenia vs those without (52.1 vs 77.0%; P <.001, and 30.2% vs 16.8%; HR, 2.2, 95%IC, 1.3-2.7) and especially in those with late nadir thrombocytopenia (45.8% vs 54.5%; P=.056, and 38.6% vs 23.8%, HR, 2.1; 95%CI, 1.5-2.9). Independent predictors of thrombocytopenia comprised baseline and procedural factors such as body surface area, absence of diabetes, poorer renal function, peripheral vascular disease, nontransfemoral access, vascular complications, type of transcatheter heart valve, and earlier TAVI procedures.CONCLUSIONS: Acquired thrombocytopenia was common (15%) after TAVI and was associated with increased short- and mid-term mortality and decreased procedural safety. Moreover, late thrombocytopenia compared with early thrombocytopenia was associated with significantly worse clinical outcomes. Further investigations are needed to elucidate the etiologic mechanisms behind these findings.

AB - INTRODUCTION AND OBJECTIVES: Thrombocytopenia frequently occurs after transcatheter aortic valve implantation (TAVI) but its impact is poorly understood. We aimed to analyze the incidence, clinical impact, and predictors of acquired thrombocytopenia after TAVI.METHODS: This retrospective multicenter registry included 3913 patients undergoing TAVI with a baseline platelet count of ≥ 100 *109/L. Acquired thrombocytopenia was defined as a decrease in baseline platelet count of ≥ 50% (early nadir ≤ 3 days and late nadir ≥ 4 days) post-TAVI. The primary endpoint was 30-day all-cause mortality and secondary endpoints were procedural safety and 2-year all-cause mortality.RESULTS: The incidence of acquired thrombocytopenia was 14.8% (early nadir: 61.5%, late nadir: 38.5%). Thirty-day mortality occurred in 112 (3.0%) patients and was significantly higher in those with thrombocytopenia (8.5% vs 2.0%, adjusted OR, 2.3; 95%CI, 1.3-4.2). Procedural safety was lower and 2-year mortality was higher in patients with thrombocytopenia vs those without (52.1 vs 77.0%; P <.001, and 30.2% vs 16.8%; HR, 2.2, 95%IC, 1.3-2.7) and especially in those with late nadir thrombocytopenia (45.8% vs 54.5%; P=.056, and 38.6% vs 23.8%, HR, 2.1; 95%CI, 1.5-2.9). Independent predictors of thrombocytopenia comprised baseline and procedural factors such as body surface area, absence of diabetes, poorer renal function, peripheral vascular disease, nontransfemoral access, vascular complications, type of transcatheter heart valve, and earlier TAVI procedures.CONCLUSIONS: Acquired thrombocytopenia was common (15%) after TAVI and was associated with increased short- and mid-term mortality and decreased procedural safety. Moreover, late thrombocytopenia compared with early thrombocytopenia was associated with significantly worse clinical outcomes. Further investigations are needed to elucidate the etiologic mechanisms behind these findings.

U2 - 10.1016/j.rec.2024.08.003

DO - 10.1016/j.rec.2024.08.003

M3 - Journal article

C2 - 39251129

SN - 1885-5857

JO - Revista espanola de cardiologia (English ed.)

JF - Revista espanola de cardiologia (English ed.)

ER -

Thrombocytopenia after transcatheter aortic valve implantation

Abstract

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