Acquired thrombocytopenia after transcatheter aortic valve replacement: clinical correlates and association with outcomes.

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Citation: European Heart Journal. 35(38):2663-71, 2014 Oct 7.PMID: 24598983Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal Article | Multicenter StudySubject headings: *Aortic Valve Stenosis/su [Surgery] | *Thrombocytopenia/et [Etiology] | *Transcatheter Aortic Valve Replacement/ae [Adverse Effects] | Aged, 80 and over | Female | Humans | Length of Stay | Male | Platelet Count | Treatment OutcomeLocal holdings: Available online from MWHC library: 1996 - present (after 1 year), Available in print through MWHC library: 1999 - 2006ISSN:
  • 0195-668X
Name of journal: European heart journalAbstract: AIMS: This study aimed to evaluate incidence and correlates for low platelet count after transcatheter aortic valve replacement (TAVR) and to determine a possible association between acquired thrombocytopenia and clinical outcomes.CONCLUSIONS: Acquired thrombocytopenia was common after TAVR and was mostly resolved at patient discharge. The severity of thrombocytopenia after TAVR could be used as an excellent, easily obtainable, marker for worse short- and long-term outcomes after the procedure.Copyright Published on behalf of the European Society of Cardiology. All rights reserved. � The Author 2014. For permissions please email: [email protected] AND RESULTS: Patients undergoing TAVR from two medical centres were included in the study. They were stratified according to nadir platelet count post procedure: no/mild thrombocytopenia, >100 x 10(9)/L; moderate, 50-99 x 10(9)/L; and severe, <50 x 10(9)/L. A total of 488 patients composed of the study population (age 84.7 +/- 7.5 years). At a median time of 2 days after TAVR, 176 patients (36.1%) developed significant thrombocytopenia: 149 (30.5%) moderate; 27 patients (5.5%) severe. Upon discharge, the vast majority of patients (90.2%) had no/mild thrombocytopenia. Nadir platelet count <50 x 10(9)/L was highly specific (96.3%), and a count <150 x 10(9)/L highly sensitive (91.2%), for predicting 30-day death (C-statistic 0.76). Patients with severe acquired thrombocytopenia had a significantly higher mortality rate at 1 year (66.7% for severe vs. 16.0% for no/mild vs. 20.1% for moderate; P < 0.001). In multivariate logistic regression, severe thrombocytopenia was independently associated with 1-year mortality (hazard ratio 3.44, CI: 1.02-11.6; P = 0.046).All authors: Badr S, Barbash IM, Ben-Dor I, Chen F, Dvir D, Fields JN, Genereux P, Hahn RT, Kirtane AJ, Kodali S, Leon MB, Loh JP, Minha S, Okubagzi PG, Pendyala LK, Pichard AD, Satler LF, Smith C, Torguson R, Waksman R, Williams M, Xu KDigital Object Identifier: Date added to catalog: 2016-01-13
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Journal Article MedStar Authors Catalog Article Available 24598983

Available online from MWHC library: 1996 - present (after 1 year), Available in print through MWHC library: 1999 - 2006

AIMS: This study aimed to evaluate incidence and correlates for low platelet count after transcatheter aortic valve replacement (TAVR) and to determine a possible association between acquired thrombocytopenia and clinical outcomes.

CONCLUSIONS: Acquired thrombocytopenia was common after TAVR and was mostly resolved at patient discharge. The severity of thrombocytopenia after TAVR could be used as an excellent, easily obtainable, marker for worse short- and long-term outcomes after the procedure.Copyright Published on behalf of the European Society of Cardiology. All rights reserved. � The Author 2014. For permissions please email: [email protected].

METHODS AND RESULTS: Patients undergoing TAVR from two medical centres were included in the study. They were stratified according to nadir platelet count post procedure: no/mild thrombocytopenia, >100 x 10(9)/L; moderate, 50-99 x 10(9)/L; and severe, <50 x 10(9)/L. A total of 488 patients composed of the study population (age 84.7 +/- 7.5 years). At a median time of 2 days after TAVR, 176 patients (36.1%) developed significant thrombocytopenia: 149 (30.5%) moderate; 27 patients (5.5%) severe. Upon discharge, the vast majority of patients (90.2%) had no/mild thrombocytopenia. Nadir platelet count <50 x 10(9)/L was highly specific (96.3%), and a count <150 x 10(9)/L highly sensitive (91.2%), for predicting 30-day death (C-statistic 0.76). Patients with severe acquired thrombocytopenia had a significantly higher mortality rate at 1 year (66.7% for severe vs. 16.0% for no/mild vs. 20.1% for moderate; P < 0.001). In multivariate logistic regression, severe thrombocytopenia was independently associated with 1-year mortality (hazard ratio 3.44, CI: 1.02-11.6; P = 0.046).

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