Preprocedural P2Y12 inhibition and decrease in platelet count following transcatheter aortic valve replacement. Issue 6 (6th May 2019)

• Record Type: Journal Article
• Authors: Ibrahim, Homam; Vapheas, Eleonora; Shah, Binita; AlKhalil, Ahmad; Querijero, Michael; Jilaihawi, Hasan; Neuburger, Peter; Staniloae, Cezar; Williams, Mathew R.
• Is Part Of: Catheterization and cardiovascular interventions. Volume 94:Issue 6(2019)
• Page Start: 812
• Page End: 817
• Publication Date: 2019-05-06
• Subjects: antithrombotics -- P2Y12 inhibition -- TAVR -- thrombocytopenia; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.28320
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Background: Thrombocytopenia after transcatheter aortic valve replacement (TAVR) is associated with adverse clinical outcomes. Whether preprocedural P2Y12 inhibition prevents postprocedural thrombocytopenia is uncertain. Methods: This retrospective analysis identified consecutive patients ( n = 266) undergoing TAVR between November 2016 and July 2017. Preprocedure clopidogrel load ≥300 mg or maintenance P2Y12 inhibitor therapy defined preprocedural P2Y12 inhibition. Patients who did not consent for the registry ( n = 8), with baseline severe thrombocytopenia (<90 × 10 3 platelets/μL; n = 14), or without baseline platelet count ( n = 4) were excluded. The primary outcome was proportion of patients who developed >20% decrease in platelet count from baseline to day 1 post‐TAVR. Results: Patients with ( n = 134) versus without ( n = 106) preprocedural P2Y12 inhibition had no differences in platelet count at baseline. Patients with preprocedural P2Y12 inhibition had a significantly lower proportion of the primary outcome (34.3% vs. 57.5%, p = .001) and a lower absolute decrease in platelet count (32.8 × 10 3 vs. 45.8 × 10 3 platelet/μL, p = .01). Of patients without baseline thrombocytopenia ( n = 198), a numerically lower rate of patients with versus without preprocedural P2Y12 inhibition developed thrombocytopenia on day 1 post‐TAVR (25.5% vs. 36.4%, p = .1). Conclusion: Patients who received preprocedural P2Y12 inhibition prior to TAVR were less likely to demonstrate a decrease in platelet count after TAVR. Prospective studies to further understand the clinical implication of these findings are warranted.