Therapeutic effect of severe thrombocytopenia in patients underwent transcatheter patent ductus arteriosus occlusion

Abstract

Objective: To investigate the therapeutic effect of severe thrombocytopenia in patients underwent transcatheter patent ductus arteriosus occlusion. Methods: Clinical data of 80 pure patent ductus arteriosus patients who underwent interventional occlusion between February 2011 and November 2014 in General Hospital of Shenyang Military Region were retrospective analyzed.A bolus of heparin calcium (80 U/kg) was administered by intravenous injection during the procedure.Blood test was conducted in all patients before and after the procedure.The patients with both platelet reduction rate ≥ 5% and platelet count <100×109/L(severe thrombocytopenia) were treated by following strategies: bed rest, avoidance of activities, intensive control of blood pressure through sodium nitroprusside administration, and inhibition of presumed immunological reaction by glucocorticoids and human immunoglobulin administration.Follow-up ended in May 2015. Results: (1) A total of 54 cases (67.5%) were diagnosed as thrombocytopenia in second days after the procedure.The reduction rate of platelet in 41 out of 54 patients was equal or more than 5% on the second day, and the diameter of occludes were equal or more than 14 mm in 35 out of these 54 patients.Severe thrombocytopenia occurred in 14 patients and the occluder diameter was ≥ 14 mm in these 14 patients.Severe thrombocytopenia did not occur in patients with occlude diameter <14 mm or with reduction rate of platelet <5%.(2) A total of 14 severe thrombocytopenia patients were treated.No bleeding events occurred in hospital and during the whole follow-up period.The the lowest value of platelet count of patients was seen on the 4.5 (3.8, 6.0) days post the procedure.The lowest numbers were 16.5 (7.5, 37.3)×109/L.The platelet count of patients restored to more than 30×109/L on the 8.0 (4.8, 9.5) days and restore to more than 100×109/L on the 12.0 (9.8, 39.3) days post procedure.The average hospitalization day of the patients were 15.5 (11.8, 21.5) days.The platelet counts of severe thrombocytopenia patients were normal during the end of follow up (median 3.8 (1.0, 4.9) years). Conclusion: The patients with very severe thrombocytopenia after transcatheter occlusion of patent ductus arteriosus are associated with a benign outcome in case of timely and proper treatment.