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Preprocedural P2Y12 inhibition and decrease in platelet count following transcatheter aortic valve replacement.

Homam Ibrahim1, Eleonora Vapheas1, Binita Shah1,2

  • 1Cardiothoracic Surgery and Cardiology Divisions, New York University School of Medicine, New York, New York.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|May 8, 2019
PubMed
Summary
This summary is machine-generated.

Preprocedural P2Y12 inhibition was associated with a reduced risk of thrombocytopenia after transcatheter aortic valve replacement (TAVR). This finding suggests a potential protective effect of P2Y12 inhibitors in TAVR patients, warranting further investigation.

Keywords:
P2Y12 inhibitionTAVRantithromboticsthrombocytopenia

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Area of Science:

  • Cardiology
  • Hematology
  • Interventional Cardiology

Background:

  • Thrombocytopenia following transcatheter aortic valve replacement (TAVR) is linked to adverse clinical outcomes.
  • The role of preprocedural P2Y12 inhibition in preventing post-TAVR thrombocytopenia remains unclear.

Purpose of the Study:

  • To investigate whether preprocedural P2Y12 inhibition reduces the incidence of thrombocytopenia after TAVR.
  • To analyze the impact of P2Y12 inhibitor therapy on platelet count changes post-TAVR.

Main Methods:

  • Retrospective analysis of 266 patients undergoing TAVR from November 2016 to July 2017.
  • Preprocedural P2Y12 inhibition defined by clopidogrel load ≥300 mg or maintenance therapy.
  • Exclusion criteria included registry non-consent, baseline severe thrombocytopenia, or missing baseline platelet counts.
  • Primary outcome: proportion of patients with >20% decrease in platelet count from baseline to day 1 post-TAVR.

Main Results:

  • Patients receiving preprocedural P2Y12 inhibition (n=134) showed a significantly lower proportion of the primary outcome (34.3% vs. 57.5%, p=0.001) compared to those without (n=106).
  • A lower absolute decrease in platelet count was observed in the P2Y12 inhibition group (32.8 × 10^3 vs. 45.8 × 10^3 platelets/μL, p=0.01).
  • Among patients without baseline thrombocytopenia, a numerically lower rate of thrombocytopenia occurred on day 1 post-TAVR with preprocedural P2Y12 inhibition (25.5% vs. 36.4%, p=0.1).

Conclusions:

  • Preprocedural P2Y12 inhibition was associated with a reduced likelihood of decreased platelet counts after TAVR.
  • These findings suggest a potential benefit of P2Y12 inhibitors in mitigating post-TAVR thrombocytopenia.
  • Prospective studies are recommended to further elucidate the clinical implications.