Author + information
- Homam Ibrahim1,
- Eleonora Vapheas1,
- Hasan Jilaihawi2,
- Cezar Staniloae3,
- Binita Shah4 and
- Mathew Williams5
- 1NYU Langone Medical Center, New York, NY, New York, New York, United States
- 2NYU Langone Medical Center, New York, California, United States
- 3NYU Medical Center, New York, New York, United States
- 4NYU Langone Medical Center, Bellevue Hospital Center, and VA NY Harbor Healthcare System, New York, New York, United States
- 5NYU Langone Medical Center, New York, New York, United States
Thrombocytopenia is common after transcatheter valve replacement (TAVR) and is associated with worse clinical outcomes. The transient platelet count drop suggests a role of platelet activation in this phenomenon. Whether adequate pre-procedural P2Y12 inhibition prevents post-procedural thrombocytopenia is not known.
We stratified consecutive patients undergoing TAVR between November 2016 and May 2017 to those with and without adequate pre-procedural P2Y12 inhibition. Adequate pre-procedural P2Y12 inhibition was defined as receiving a loading dose of a P2Y12 inhibitor on the day of the procedure or chronic P2Y12 inhibitor treatment at least 1 week prior to the procedure. Patients with a baseline severe thrombocytopenia (i.e. < 90 x103 platelet/mL) due to hematological disorder were excluded. The primary outcome was the number of patients who developed > 30% drop in platelet count from baseline to post-TAVR. In a subanalysis of patients without baseline thrombocytopenia (defined as platelet count <150 x 103 platelets/mL), the proportion of patients who developed thrombocytopenia post-TAVR was evaluated.
Of the 208 TAVR procedures performed during the study period, 17 patients (8.2%) were excluded due to baseline severe thrombocytopenia (n=13) or no baseline platelet count (n=4). Of the remaining 191 patients, patients with (n=101) and without (n =90) adequate P2Y12 inhibition had similar age (80 + 8 vs. 81 + 8 years, p= 0.4) and baseline platelet count (203 x 103+ 56 vs. 211 x 103 platelet/uL + 64, p=0.3). More patients without adequate p2Y12 inhibition dropped their platelet count by >30% post-TAVR (25% vs. 14%, p= 0.045). After excluding baseline thrombocytopenia.
Patients undergoing TAVR who receive adequate pre-procedural P2Y12 inhibition are less likely to drop their platelet count by >30% from baseline or develop thrombocytopenia after TAVR. Prospective studies to further understand the clinical implication of these findings are warranted.
STRUCTURAL: Valvular Disease: Aortic