Thrombocytopenia post Transcatheter Aortic Valve Insertion: Clinical and Prognostic Significance

Abstract

ABSTRACT Background: Transcatheter aortic valve insertion (TAVI) has revolutionized the management of aortic stenosis in patients at high surgical risk. Major thrombocytopenia has previously been assessed as a predictor of short- and long-term mortality. This study aimed at identifying the predictors and prognostic value of major thrombocytopenia post TAVI. Methods: Patients who underwent TAVI at a metropolitan quaternary referral centre in Australia over an 8-year period were included. Primary outcomes included 30-day and 1-year mortality. Secondary outcomes included Bleeding Academic Research Consortium (BARC) minor, major and life-threatening bleeding. Baseline characteristics and platelet counts were collected retrospectively. Results: A total of 331 consecutive patients were included in the analysis. The only predictor of major thrombocytopenia was pre-procedural platelet count (p < 0.01). Patients who had major thrombocytopenia post TAVI had increased 30-day mortality (OR 4.37, 95% CI 1.35–14.16, p = 0.014) but this did not extend to 1-year mortality (OR1.67, 95 CI 0.64–4.36, p = 0.29). Patients with major thrombocytopenia had an increased rate of major and life-threatening bleeding (OR 2.01, 95% CI 1.2–2.4, p = 0.01). Conclusion: Thrombocytopenia post TAVI is common and may contribute to worse short-term outcome. Larger studies into the mechanism and prevention of thrombocytopenia post TAVI are warranted.