title: Major thrombocytopenia after balloon-expandable transcatheter aortic valve replacement: prognostic implications and comparison to surgical aortic valve replacement.
abstract: OBJECTIVE
  We sought to investigate the magnitude and clinical importance of thrombocytopenia post transcatheter aortic valve replacement (TAVR).
  
  
  BACKGROUND
  Thrombocytopenia has been observed after TAVR but has not been well studied.
  
  
  METHODS
  Major thrombocytopenia (platelet count <100 × 10(9) /L) was studied following aortic valve interventions in a single center. Changes in platelets were compared in 246 patients undergoing balloon-expandable TAVR and a similar population of 57 cases undergoing surgical aortic valve replacement (SAVR in the US PARTNER IA trial).
  
  
  RESULTS
  An early drop in platelets was seen on the day of intervention. The drop day 1 post procedure was similar but slightly greater with SAVR vs. TAVR. In both platelet counts continued to drop, reaching a nadir of approximately 50-60% of the baseline platelet count at day 2-3, starting to recover after day 5. Early major thrombocytopenia occurred post TAVR in 37% of patients but was not significantly related to major bleeding (OR 0.89, 95% CI 0.51-1.60, P = 0.69) or risk of stroke (HR 0.61, 95% CI 0.16-2.20, P = 0.45); there was a trend to greater acute kidney injury (OR 1.76, 95% CI 0.95-3.26, P = 0.073) and mortality (HR 1.47, 95% CI 0.98-2.22, P = 0.065). Major thrombocytopenia was persistent in 7.7% of patients and this was independently associated with mortality (HR 3.65, 95% CI 1.63-8.16, P = 0.002).
  
  
  CONCLUSIONS
  Post-TAVR thrombocytopenia is a common phenomenon and its magnitude appears similar to that seen after SAVR. It is most often transient, not associated with adverse sequelae and, unless persistent, should be managed in an expectant fashion. © 2014 Wiley Periodicals, Inc.
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Hasan
authors.initials: H
authors.lastname: Jilaihawi
authors.forename: Niraj
authors.initials: N
authors.lastname: Doctor
authors.forename: Tarun
authors.initials: T
authors.lastname: Chakravarty
authors.forename: Mohammad
authors.initials: M
authors.lastname: Kashif
authors.forename: James
authors.initials: J
authors.lastname: Mirocha
authors.forename: Wen
authors.initials: W
authors.lastname: Cheng
authors.forename: Michael
authors.initials: M
authors.lastname: Lill
authors.forename: Mamoo
authors.initials: M
authors.lastname: Nakamura
authors.forename: Mitch
authors.initials: M
authors.lastname: Gheorghiu
authors.forename: Raj R
authors.initials: RR
authors.lastname: Makkar
mesh_terms: D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods / Q000401:mortality; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016017:Odds Ratio; D010976:Platelet Count; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013921:Thrombocytopenia / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome
keywords: TAVI; TAVR; aortic valve replacement; outcomes; thrombocytopenia