39 Incidence of post-TAVI thrombocytopenia and prognostic implications for TAVI outcomes: an Irish tertiary centre experience

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Introduction Predictors for major complications of transcatheter aortic valve implantation (TAVI) remains a challenge, and is important because of their association with poor outcomes (1). Thrombocytopenia is a well-recognized phenomenon following TAVI (2), however its mechanisms and implications remain uncertain with conflicting observational data about its association with poor TAVI-related outcomes (3, 4). We aimed to assess the characteristics and outcomes of patients who develop post-TAVI thrombocytopenia in an Irish setting. Methods A retrospective registry was created which included data on consecutive patients who underwent TAVI in St. James’s Hospital, Dublin over a 3-year period (2019 to 2021). The hospital’s electronic health record was used to collect relevant data. Patients without both baseline and post-TAVI platelet values available were excluded from this analysis. Thrombocytopenia was classified according to nadir platelet count post-procedure: no/mild thrombocytopenia (≥ 100 x 109/L), moderate (50-99 x 109/L), severe (<50 x 109/L). The Valve Academic Research Consortium 3 (VARC-3) guideline was used to define clinical endpoint definitions (5). This study received ethics approval from the SJH/TUH joint research ethics committee. Statistical analysis was performed using Stata Version 18.2. Results A total of 230 TAVI procedures were performed in the 3-year period, with baseline and post-procedural platelet values available in 134 (58%) cases. Amongst these, 70 (52%) developed post-TAVI thrombocytopenia; 43 (61%) with mild, 24 (34%) with moderate and 3 (4%) with severe thrombocytopenia. Baseline characteristics comparing patients who did and did not develop post-TAVI thrombocytopenia are described in table 1. Male gender (80% vs 53%, p<0.001) and baseline thrombocytopenia (47% vs 3%, p<0.0001 were more common in patients who developed post-TAVI thrombocytopenia. Similarly, mean creatinine was higher in this group (112 vs 96.5 mg/dL, p = 0.04), however baseline estimated glomerular filtration rate was similar between groups (49 vs 60 ml/min/1.73 m2, p = 0.70). Comparative outcomes between patients who did and did not develop thrombocytopenia post-procedure are represented in figure 1. One-year all-cause mortality trended higher in thrombocytopenic patients [7 (10%) vs 2 (3%), p=0.97]. A similar trend was seen for bleeding academic research consortium (BARC) 3-5 bleeding trended higher in the thrombocytopenic group [11 (16%) vs 7 (11%), p=0.78]. In-hospital stroke was seen in twice as many patients in the thrombocytopenic group [6 (9%) vs 3 (5%), p=0.94], as were any vascular complications [15 (21%) vs 7 (11%), p=0.61]. Median hospital stay was similar between groups [9 (IQR 5-20) days in thrombocytopenic group vs 11 (IQR 5-22) days in normal platelet group, p=0.16]. Conclusion Acquired thrombocytopenia was common in our Irish TAVI cohort, but few patients developed severe thrombocytopenia which was consistent with international trends (6). Baseline thrombocytopenia and male gender were more common in patients who developed post-TAVI thrombocytopenia in our cohort. Post-procedural thrombocytopenia may be a poor prognostic factor, being associated with higher rates of important TAVI-related complications, including major bleeding, vascular complications, one-year mortality and in-hospital stroke. However, well-powered inferential analyses with larger cohorts is warranted to test these hypotheses.

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