Predictors and clinical impact of pre-existing and acquired thrombocytopenia following transcatheter aortic valve replacement
Background Data are limited regarding transcatheter aortic valve replacement (TAVR)‐related thrombocytopenia (TP). We sought to thoroughly characterize the presence, clinical impact, and severity of TP associated with TAVR. Methods and Results Data were collected from 90 patients who underwent TAVR...
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| Veröffentlicht in: | Catheterization and cardiovascular interventions 2015-01, Vol.85 (1), p.118-129 |
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| creator | Flaherty, Michael P. Mohsen, Amr Moore, Joseph B. Bartoli, Carlo R. Schneibel, Erik Rawasia, Wasiq Williams, Matthew L. Grubb, Kendra J. Hirsch, Glenn A. |
| description | Background
Data are limited regarding transcatheter aortic valve replacement (TAVR)‐related thrombocytopenia (TP). We sought to thoroughly characterize the presence, clinical impact, and severity of TP associated with TAVR.
Methods and Results
Data were collected from 90 patients who underwent TAVR using the Edwards SAPIEN valve (59 TF, 29 TA, 2 Tao). Platelet counts were evaluated peri‐procedurally and for 8 days following TAVR. Platelet levels were compared and patients were divided into a no TP (No‐TP) group 1, acquired (new) TP (NTP) group 2, pre‐existing (pre‐TAVR) TP (PTP) group 3, and further stratified based on the severity of TP: mild (M) TP (100–149 × 103 cell/µL) and moderate–severe (MS) TP ( |
| doi_str_mv | 10.1002/ccd.25668 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1639492276</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1639492276</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5628-68ec30b93995a8c15b7b240f467f291414c34f2e5b9520c947903bd7f2cfc8293</originalsourceid><addsrcrecordid>eNp10ctu1DAUBuAIgegFFrwAssSGLtL6EjvxEgUoiApGoojuLOfEoS5OnNpO21nw7ng60y6QWNmSv_PLR39RvCL4mGBMTwD6Y8qFaJ4U-4RTWtZUXDzd3YmsxF5xEOMVxlgKKp8Xe5RTXDHc7Bd_VsH0FpIPEempR-DsZEE7ZMdZQ0J-QHMwpbmzMdnp173RcL3YPIbSZfBj52Gd_Gwmq9HgnfO3G5eCniLodGmSCUj7kCygG-1uDApmdhrMaKb0ong2aBfNy915WPz4-OG8_VSefTv93L47K4EL2pSiMcBwJ5mUXDdAeFd3tMJDJeqBSlKRClg1UMM7mRcDWdUSs67PjzBAQyU7LN5uc-fgrxcTkxptBOOcnoxfoiKCyUpSWotM3_xDr_wSpvy7jRINI0TyrI62CoKPMZhBzcGOOqwVwWrTicqdqPtOsn29S1y60fSP8qGEDE624NY6s_5_kmrb9w-R5XYit2LuHid0-K1EzWqufn49VStyvvry_aJVnP0FWcemWA</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1636831195</pqid></control><display><type>article</type><title>Predictors and clinical impact of pre-existing and acquired thrombocytopenia following transcatheter aortic valve replacement</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><creator>Flaherty, Michael P. ; Mohsen, Amr ; Moore, Joseph B. ; Bartoli, Carlo R. ; Schneibel, Erik ; Rawasia, Wasiq ; Williams, Matthew L. ; Grubb, Kendra J. ; Hirsch, Glenn A.</creator><creatorcontrib>Flaherty, Michael P. ; Mohsen, Amr ; Moore, Joseph B. ; Bartoli, Carlo R. ; Schneibel, Erik ; Rawasia, Wasiq ; Williams, Matthew L. ; Grubb, Kendra J. ; Hirsch, Glenn A.</creatorcontrib><description>Background
Data are limited regarding transcatheter aortic valve replacement (TAVR)‐related thrombocytopenia (TP). We sought to thoroughly characterize the presence, clinical impact, and severity of TP associated with TAVR.
Methods and Results
Data were collected from 90 patients who underwent TAVR using the Edwards SAPIEN valve (59 TF, 29 TA, 2 Tao). Platelet counts were evaluated peri‐procedurally and for 8 days following TAVR. Platelet levels were compared and patients were divided into a no TP (No‐TP) group 1, acquired (new) TP (NTP) group 2, pre‐existing (pre‐TAVR) TP (PTP) group 3, and further stratified based on the severity of TP: mild (M) TP (100–149 × 103 cell/µL) and moderate–severe (MS) TP (<100 × 103 cell/µL). Pre‐TAVR point prevalence and post‐TAVR incidence of TP were 40% and 79%, respectively (P < 0.001); nadir platelet count in all groups occurred day 4 post‐TAVR. Baseline predictors for developing MS TP in groups 2–3 included baseline TP, leaner body mass, smaller pre‐procedural aortic valve area, higher peak aortic jet velocity, and worsening baseline renal function. Development of “major” TP (nadir platelet count <100 × 103 cell/µL, ≥50% decrease) predicted a higher risk of major vascular complications (OR 2.78 [95% CI, 1.58–3.82]) and major bleeding (OR 3.18 [95% CI, 1.33–5.42]) in group 3.
Conclusion
TAVR‐related TP is predictable and classification by PTP and TP severity prior to TAVR allows for better risk stratification in predicting in‐hospital clinical outcomes. Major TP in the presence of worsening TP is predictable and is associated with worse clinical outcomes. © 2014 Wiley Periodicals, Inc.</description><identifier>ISSN: 1522-1946</identifier><identifier>EISSN: 1522-726X</identifier><identifier>DOI: 10.1002/ccd.25668</identifier><identifier>PMID: 25204308</identifier><identifier>CODEN: CARIF2</identifier><language>eng</language><publisher>United States: Blackwell Publishing Ltd</publisher><subject>Aged ; Aged, 80 and over ; Aortic Valve Stenosis - therapy ; Cardiac Catheterization - adverse effects ; Cardiac Catheterization - instrumentation ; Cardiac Catheterization - methods ; Chi-Square Distribution ; Clinical outcomes ; Drug therapy ; Female ; Heart Valve Prosthesis ; Heart Valve Prosthesis Implantation - adverse effects ; Heart Valve Prosthesis Implantation - instrumentation ; Heart Valve Prosthesis Implantation - methods ; Humans ; Kentucky ; Logistic Models ; Male ; Multivariate Analysis ; Odds Ratio ; Platelet Count ; Predictive Value of Tests ; predictors ; Prosthesis Design ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Severity of Illness Index ; TAVR ; thrombocytopenia ; Thrombocytopenia - blood ; Thrombocytopenia - diagnosis ; Thrombocytopenia - etiology ; Time Factors ; Treatment Outcome</subject><ispartof>Catheterization and cardiovascular interventions, 2015-01, Vol.85 (1), p.118-129</ispartof><rights>2014 Wiley Periodicals, Inc.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5628-68ec30b93995a8c15b7b240f467f291414c34f2e5b9520c947903bd7f2cfc8293</citedby><cites>FETCH-LOGICAL-c5628-68ec30b93995a8c15b7b240f467f291414c34f2e5b9520c947903bd7f2cfc8293</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fccd.25668$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fccd.25668$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>315,782,786,1419,27933,27934,45583,45584</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25204308$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Flaherty, Michael P.</creatorcontrib><creatorcontrib>Mohsen, Amr</creatorcontrib><creatorcontrib>Moore, Joseph B.</creatorcontrib><creatorcontrib>Bartoli, Carlo R.</creatorcontrib><creatorcontrib>Schneibel, Erik</creatorcontrib><creatorcontrib>Rawasia, Wasiq</creatorcontrib><creatorcontrib>Williams, Matthew L.</creatorcontrib><creatorcontrib>Grubb, Kendra J.</creatorcontrib><creatorcontrib>Hirsch, Glenn A.</creatorcontrib><title>Predictors and clinical impact of pre-existing and acquired thrombocytopenia following transcatheter aortic valve replacement</title><title>Catheterization and cardiovascular interventions</title><addtitle>Cathet. Cardiovasc. Intervent</addtitle><description>Background
Data are limited regarding transcatheter aortic valve replacement (TAVR)‐related thrombocytopenia (TP). We sought to thoroughly characterize the presence, clinical impact, and severity of TP associated with TAVR.
Methods and Results
Data were collected from 90 patients who underwent TAVR using the Edwards SAPIEN valve (59 TF, 29 TA, 2 Tao). Platelet counts were evaluated peri‐procedurally and for 8 days following TAVR. Platelet levels were compared and patients were divided into a no TP (No‐TP) group 1, acquired (new) TP (NTP) group 2, pre‐existing (pre‐TAVR) TP (PTP) group 3, and further stratified based on the severity of TP: mild (M) TP (100–149 × 103 cell/µL) and moderate–severe (MS) TP (<100 × 103 cell/µL). Pre‐TAVR point prevalence and post‐TAVR incidence of TP were 40% and 79%, respectively (P < 0.001); nadir platelet count in all groups occurred day 4 post‐TAVR. Baseline predictors for developing MS TP in groups 2–3 included baseline TP, leaner body mass, smaller pre‐procedural aortic valve area, higher peak aortic jet velocity, and worsening baseline renal function. Development of “major” TP (nadir platelet count <100 × 103 cell/µL, ≥50% decrease) predicted a higher risk of major vascular complications (OR 2.78 [95% CI, 1.58–3.82]) and major bleeding (OR 3.18 [95% CI, 1.33–5.42]) in group 3.
Conclusion
TAVR‐related TP is predictable and classification by PTP and TP severity prior to TAVR allows for better risk stratification in predicting in‐hospital clinical outcomes. Major TP in the presence of worsening TP is predictable and is associated with worse clinical outcomes. © 2014 Wiley Periodicals, Inc.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Aortic Valve Stenosis - therapy</subject><subject>Cardiac Catheterization - adverse effects</subject><subject>Cardiac Catheterization - instrumentation</subject><subject>Cardiac Catheterization - methods</subject><subject>Chi-Square Distribution</subject><subject>Clinical outcomes</subject><subject>Drug therapy</subject><subject>Female</subject><subject>Heart Valve Prosthesis</subject><subject>Heart Valve Prosthesis Implantation - adverse effects</subject><subject>Heart Valve Prosthesis Implantation - instrumentation</subject><subject>Heart Valve Prosthesis Implantation - methods</subject><subject>Humans</subject><subject>Kentucky</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Multivariate Analysis</subject><subject>Odds Ratio</subject><subject>Platelet Count</subject><subject>Predictive Value of Tests</subject><subject>predictors</subject><subject>Prosthesis Design</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Severity of Illness Index</subject><subject>TAVR</subject><subject>thrombocytopenia</subject><subject>Thrombocytopenia - blood</subject><subject>Thrombocytopenia - diagnosis</subject><subject>Thrombocytopenia - etiology</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><issn>1522-1946</issn><issn>1522-726X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp10ctu1DAUBuAIgegFFrwAssSGLtL6EjvxEgUoiApGoojuLOfEoS5OnNpO21nw7ng60y6QWNmSv_PLR39RvCL4mGBMTwD6Y8qFaJ4U-4RTWtZUXDzd3YmsxF5xEOMVxlgKKp8Xe5RTXDHc7Bd_VsH0FpIPEempR-DsZEE7ZMdZQ0J-QHMwpbmzMdnp173RcL3YPIbSZfBj52Gd_Gwmq9HgnfO3G5eCniLodGmSCUj7kCygG-1uDApmdhrMaKb0ong2aBfNy915WPz4-OG8_VSefTv93L47K4EL2pSiMcBwJ5mUXDdAeFd3tMJDJeqBSlKRClg1UMM7mRcDWdUSs67PjzBAQyU7LN5uc-fgrxcTkxptBOOcnoxfoiKCyUpSWotM3_xDr_wSpvy7jRINI0TyrI62CoKPMZhBzcGOOqwVwWrTicqdqPtOsn29S1y60fSP8qGEDE624NY6s_5_kmrb9w-R5XYit2LuHid0-K1EzWqufn49VStyvvry_aJVnP0FWcemWA</recordid><startdate>20150101</startdate><enddate>20150101</enddate><creator>Flaherty, Michael P.</creator><creator>Mohsen, Amr</creator><creator>Moore, Joseph B.</creator><creator>Bartoli, Carlo R.</creator><creator>Schneibel, Erik</creator><creator>Rawasia, Wasiq</creator><creator>Williams, Matthew L.</creator><creator>Grubb, Kendra J.</creator><creator>Hirsch, Glenn A.</creator><general>Blackwell Publishing Ltd</general><general>Wiley Subscription Services, Inc</general><scope>BSCLL</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7T5</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>20150101</creationdate><title>Predictors and clinical impact of pre-existing and acquired thrombocytopenia following transcatheter aortic valve replacement</title><author>Flaherty, Michael P. ; Mohsen, Amr ; Moore, Joseph B. ; Bartoli, Carlo R. ; Schneibel, Erik ; Rawasia, Wasiq ; Williams, Matthew L. ; Grubb, Kendra J. ; Hirsch, Glenn A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5628-68ec30b93995a8c15b7b240f467f291414c34f2e5b9520c947903bd7f2cfc8293</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Aortic Valve Stenosis - therapy</topic><topic>Cardiac Catheterization - adverse effects</topic><topic>Cardiac Catheterization - instrumentation</topic><topic>Cardiac Catheterization - methods</topic><topic>Chi-Square Distribution</topic><topic>Clinical outcomes</topic><topic>Drug therapy</topic><topic>Female</topic><topic>Heart Valve Prosthesis</topic><topic>Heart Valve Prosthesis Implantation - adverse effects</topic><topic>Heart Valve Prosthesis Implantation - instrumentation</topic><topic>Heart Valve Prosthesis Implantation - methods</topic><topic>Humans</topic><topic>Kentucky</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Multivariate Analysis</topic><topic>Odds Ratio</topic><topic>Platelet Count</topic><topic>Predictive Value of Tests</topic><topic>predictors</topic><topic>Prosthesis Design</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Severity of Illness Index</topic><topic>TAVR</topic><topic>thrombocytopenia</topic><topic>Thrombocytopenia - blood</topic><topic>Thrombocytopenia - diagnosis</topic><topic>Thrombocytopenia - etiology</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Flaherty, Michael P.</creatorcontrib><creatorcontrib>Mohsen, Amr</creatorcontrib><creatorcontrib>Moore, Joseph B.</creatorcontrib><creatorcontrib>Bartoli, Carlo R.</creatorcontrib><creatorcontrib>Schneibel, Erik</creatorcontrib><creatorcontrib>Rawasia, Wasiq</creatorcontrib><creatorcontrib>Williams, Matthew L.</creatorcontrib><creatorcontrib>Grubb, Kendra J.</creatorcontrib><creatorcontrib>Hirsch, Glenn A.</creatorcontrib><collection>Istex</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Immunology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Catheterization and cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Flaherty, Michael P.</au><au>Mohsen, Amr</au><au>Moore, Joseph B.</au><au>Bartoli, Carlo R.</au><au>Schneibel, Erik</au><au>Rawasia, Wasiq</au><au>Williams, Matthew L.</au><au>Grubb, Kendra J.</au><au>Hirsch, Glenn A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Predictors and clinical impact of pre-existing and acquired thrombocytopenia following transcatheter aortic valve replacement</atitle><jtitle>Catheterization and cardiovascular interventions</jtitle><addtitle>Cathet. Cardiovasc. Intervent</addtitle><date>2015-01-01</date><risdate>2015</risdate><volume>85</volume><issue>1</issue><spage>118</spage><epage>129</epage><pages>118-129</pages><issn>1522-1946</issn><eissn>1522-726X</eissn><coden>CARIF2</coden><abstract>Background
Data are limited regarding transcatheter aortic valve replacement (TAVR)‐related thrombocytopenia (TP). We sought to thoroughly characterize the presence, clinical impact, and severity of TP associated with TAVR.
Methods and Results
Data were collected from 90 patients who underwent TAVR using the Edwards SAPIEN valve (59 TF, 29 TA, 2 Tao). Platelet counts were evaluated peri‐procedurally and for 8 days following TAVR. Platelet levels were compared and patients were divided into a no TP (No‐TP) group 1, acquired (new) TP (NTP) group 2, pre‐existing (pre‐TAVR) TP (PTP) group 3, and further stratified based on the severity of TP: mild (M) TP (100–149 × 103 cell/µL) and moderate–severe (MS) TP (<100 × 103 cell/µL). Pre‐TAVR point prevalence and post‐TAVR incidence of TP were 40% and 79%, respectively (P < 0.001); nadir platelet count in all groups occurred day 4 post‐TAVR. Baseline predictors for developing MS TP in groups 2–3 included baseline TP, leaner body mass, smaller pre‐procedural aortic valve area, higher peak aortic jet velocity, and worsening baseline renal function. Development of “major” TP (nadir platelet count <100 × 103 cell/µL, ≥50% decrease) predicted a higher risk of major vascular complications (OR 2.78 [95% CI, 1.58–3.82]) and major bleeding (OR 3.18 [95% CI, 1.33–5.42]) in group 3.
Conclusion
TAVR‐related TP is predictable and classification by PTP and TP severity prior to TAVR allows for better risk stratification in predicting in‐hospital clinical outcomes. Major TP in the presence of worsening TP is predictable and is associated with worse clinical outcomes. © 2014 Wiley Periodicals, Inc.</abstract><cop>United States</cop><pub>Blackwell Publishing Ltd</pub><pmid>25204308</pmid><doi>10.1002/ccd.25668</doi><tpages>12</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Aged, 80 and over Aortic Valve Stenosis - therapy Cardiac Catheterization - adverse effects Cardiac Catheterization - instrumentation Cardiac Catheterization - methods Chi-Square Distribution Clinical outcomes Drug therapy Female Heart Valve Prosthesis Heart Valve Prosthesis Implantation - adverse effects Heart Valve Prosthesis Implantation - instrumentation Heart Valve Prosthesis Implantation - methods Humans Kentucky Logistic Models Male Multivariate Analysis Odds Ratio Platelet Count Predictive Value of Tests predictors Prosthesis Design Retrospective Studies Risk Assessment Risk Factors Severity of Illness Index TAVR thrombocytopenia Thrombocytopenia - blood Thrombocytopenia - diagnosis Thrombocytopenia - etiology Time Factors Treatment Outcome |
| title | Predictors and clinical impact of pre-existing and acquired thrombocytopenia following transcatheter aortic valve replacement |
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