Publication: Incidence and clinical outcomes of thrombocytopenia after transcatheter aortic valve replacement in thai patients
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Issued Date
2021-07-01
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ISSN
01252208
Other identifier(s)
2-s2.0-85110721121
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Mahidol University
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SCOPUS
Bibliographic Citation
Journal of the Medical Association of Thailand. Vol.104, No.7 (2021), 1192-1198
Suggested Citation
Kittima Kungvivatana, Nattawut Wongpraparut, Decho Jakrapanichakul, Narathip Chunhamaneewat, Adisak Maneesai, Vithaya Chaitriraphan, Pranya Sakiyalak, Worawong Slisatkorn, Vutthipong Sanphasitvong, Kamheang Vacharaksa, Kasana Raksamani, Asa Phichaphop, Korakoth Towashiraporn, Roongthip Chanwanitkulchai, Prayuth Rasmeehiran, Sirichai Jamnongprasatporn, Pariya Panchavinnin, Chunhakasem Chotinaiwattarakul, Rungtiwa Pongakasira Incidence and clinical outcomes of thrombocytopenia after transcatheter aortic valve replacement in thai patients. Journal of the Medical Association of Thailand. Vol.104, No.7 (2021), 1192-1198. doi:10.35755/jmedassocthai.2021.07.12754 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/78065
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Title
Incidence and clinical outcomes of thrombocytopenia after transcatheter aortic valve replacement in thai patients
Author(s)
Kittima Kungvivatana
Nattawut Wongpraparut
Decho Jakrapanichakul
Narathip Chunhamaneewat
Adisak Maneesai
Vithaya Chaitriraphan
Pranya Sakiyalak
Worawong Slisatkorn
Vutthipong Sanphasitvong
Kamheang Vacharaksa
Kasana Raksamani
Asa Phichaphop
Korakoth Towashiraporn
Roongthip Chanwanitkulchai
Prayuth Rasmeehiran
Sirichai Jamnongprasatporn
Pariya Panchavinnin
Chunhakasem Chotinaiwattarakul
Rungtiwa Pongakasira
Nattawut Wongpraparut
Decho Jakrapanichakul
Narathip Chunhamaneewat
Adisak Maneesai
Vithaya Chaitriraphan
Pranya Sakiyalak
Worawong Slisatkorn
Vutthipong Sanphasitvong
Kamheang Vacharaksa
Kasana Raksamani
Asa Phichaphop
Korakoth Towashiraporn
Roongthip Chanwanitkulchai
Prayuth Rasmeehiran
Sirichai Jamnongprasatporn
Pariya Panchavinnin
Chunhakasem Chotinaiwattarakul
Rungtiwa Pongakasira
Other Contributor(s)
Abstract
Background: Post-transcatheter aortic valve replacement (TAVR) thrombocytopenia has been reported to be a predictor of higher mortality and worse clinical outcomes in published studies mostly from Western countries; however, data from Asian countries are generally limited, while data from Thai population are lacking. Objective: To evaluate the incidence and outcomes of Thai patients who developed thrombocytopenia after TAVR. Materials and Methods: The present research was a retrospective observational study. The authors collected data from patients underwent TAVR at Siriraj Hospital between 2009 and 2019. The patients were stratified into four groups according to nadir platelet count, no thrombocytopenia with platelet of 150,000/uL or more, mild with platelet of 100,000 to 149,999/uL, moderate at 50,000 to 99,999/uL and severe at less than 50,000/ uL. In addition, the patients with moderate to severe thrombocytopenia were stratified into two groups according to the percentage decline in platelet count (DPC) post procedure as DPC of less than 50% or DPC of 50% or more from the baseline platelet count. Results: Eighty-three patients were reviewed. One patient who died intraoperatively was excluded. Thrombocytopenia occurred in 62 patients (75.6%), in which 36.6% (n=30) of the cases were classed as moderate, and 8.5% (n=7) as severe thrombocytopenia. The platelet count returned to baseline before discharge or during the follow-up period in 83.8% (n=52) of patients. The incidence of in-hospital mortality was significantly higher in patients with severe thrombocytopenia than those with mild thrombocytopenia at 28.6% versus 4% (p=0.011). The duration of admission, length of stay in the CCU, incidence of life-threatening bleeding, clopidogrel discontinuation, platelet transfusion, rate of infection, shock, and acute kidney injury were also significantly higher in patients with moderate to severe thrombocytopenia. Conclusion: Acquired thrombocytopenia after TAVR is a common phenomenon in Thai patients (75%) but usually transient with a nadir platelet count greater than 50,000/uL. Most patients had spontaneous platelet recovery. The presence of severe thrombocytopenia with a nadir platelet count of less than 50,000 is a red flag sign for concomitant infection. The severity of thrombocytopenia is significantly associated with higher mortality and post-procedural adverse events.