Highlights
- •The mechanism of TP following TAVI is complex and mediated by some platelet as well as blood coagulation activation factors.
- •Platelet reduction shortly after TAVI procedure might be related to the amount of contrast.
- •Enhanced platelet activation following TAVI might justify the use of the second antiplatelet agent after the procedure.
Abstract
Introduction
Even though thrombocytopenia following transcatheter aortic valve implantation (TAVI)
has been described, further investigation of this phenomenon is needed.
Aims
To determine which factors may explain the fall in platelet count that occurs after
implantation of a TAVI device, including markers of platelet and blood coagulation
activation.
Material and methods
32 patients without previous indications for dual antiplatelet therapy (mean age 78.5 ± 7.9 years, 62% females) with severe aortic valve stenosis (mean gradient 54.6 ± 16.9 mm Hg) who qualified for TAVI procedure (Edwards Sapien XT) were prospectively analyzed.
Platelet counts were analyzed before the surgery, on the day of the procedure and
for the three following postoperative days (POD 1 to 3). To assess platelet activation
P-selectin (PS, serum) and platelet factor 4 (PF-4, CTAD plasma) were measured, whereas
for the evaluation of coagulation activation prothrombin fragments 1 + 2 (F1 + 2, plasma) were assessed before the procedure, on POD-1 and POD-3 (ELISA).
Results
During the postoperative period a significant platelet count drop, the most evident
on POD-2, was observed followed by a platelet count raise. The platelet count drop
correlated directly with the amount of iodinated contrast agent (r = 0.42, p = 0.016) and inversely with baseline mean platelet volume (r = −0.37, p = 0.046). Neither clinical nor perioperative parameters, except contrast medium, influenced
platelet count decrease. No significant differences regarding the concentration of
the evaluated markers in patients with and without thrombocytopenia were found. PF-4
and F1 + 2 significantly changed during the study (p < 0.05). Greater acute PF-4 decrease correlated with greater acute platelet count drop
(r = 0.48, p = 0.043), and during the study slower PF-4 increase correlated with higher platelet
count increase on POD-3 (r = −0.505, p = 0.032). Lower baseline PS correlated with lower baseline platelet count and higher
platelet count increase on POD-3 (r = 0.45, p = 0.04 and =−0.55, p = 0.02, respectively). No significant correlations between F1 + 2 concentrations and platelet count changes have been found.
Conclusions
Platelet reduction shortly after TAVI procedure is related to the amount of contrast
agent applied during the procedure. Platelet activation and blood coagulation along
with impaired baseline platelet renewal might be the mechanisms of thrombocytopenia
following TAVI procedure.
Abbreviations:
F1+2 (prothrombin fragments 1+2), MPV (mean platelet volume), PF-4 (platelet factor 4), POD (postoperative day), PS (P-selectin), TAVI (transcatheter aortic valve implantation)Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Thrombosis ResearchAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Acquired thrombocytopenia after transcatheter aortic valve replacement: clinical correlates and association with outcomes.Eur. Heart J. 2014; 35: 2663-2671
- Thrombocytopenia and perioperative complications after stentless freedom solo valve implantation.Kardiol. Pol. 2013; 71: 334-340
- Acute and chronic changes in platelet volume and count after cardiopulmonary bypass induced thrombocytopenia in man.Thromb. Haemost. 1987; 57: 55-58
- Decline in platelet count in patients treated by percutaneous coronary intervention: definition, incidence, prognostic importance, and predictive factors.Eur. Heart J. 2010; 31: 1079-1087
- Predictors and clinical impact of pre-existing and acquired thrombocytopenia following transcatheter aortic valve replacement.Catheter. Cardiovasc. Interv. 2015; 85: 118-129
- Major thrombocytopenia after balloon-expandable transcatheter aortic valve replacement: prognostic implications and comparison to surgical aortic valve replacement.Catheter. Cardiovasc. Interv. 2015; 85: 130-137
- Assessment of the markers of platelet and coagulation activation following transcatheter closure of atrial septal defects.Int. J. Cardiol. 2005; 98: 107-112
- The role of PF4 (CXCL4) in the process of clot formation.Acta Haematol. Pol. 2012; 43: 150-154
- Mean platelet volume on admission predicts impaired reperfusion and long-term mortality in acute myocardial infarction treated with primary percutaneous coronary intervention.J. Am. Coll. Cardiol. 2005; 46: 284-290
- Mean platelet volume as a predictor of cardiovascular risk: a systematic review and meta-analysis.J. Thromb. Haemost. 2010; 8: 148-156
- Incidence and implications of idiopathic thrombocytopenia following transcatheter aortic valve replacement with the Edwards Sapien(©) valves: a single center experience.Catheter. Cardiovasc. Interv. 2014; 83: 633-641
- Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document (VARC-2).J. Thorac. Cardiovasc. Surg. 2013; 145: 6-23
- Impact of mean platelet volume on combined safety endpoint and vascular and bleeding complications following percutaneous transfemoral transcatheter aortic valve implantation.Biomed. Res. Int. 2013; 645265
- Effect of transcatheter (via femoral artery) aortic valve implantation on the platelet count and its consequences.Am. J. Cardiol. 2013; 111: 1619-1624
- Predictors of 6-month poor clinical outcomes after transcatheter aortic valve implantation.Arch. Cardiovasc. Dis. 2014; 107: 10-20
- Thrombocytopenia and iodinated contrast.J. Investig. Allergol. Clin. Immunol. 2009; 19: 511-512
- Acute severe thrombocytopenia following non-ionic low-osmolarity intravenous contrast medium injection.Korean J. Radiol. 2012; 13: 505-509
- TAVI induces an elevation of hemostasis-related biomarkers, which is not causative for post-TAVI thrombocytopenia.Int. J. Cardiol. 2016; 221: 719-725
- Thromboinflammatory response and predictors of outcomes in patients undergoing transcatheter aortic valve replacement.J. Thromb. Thrombolysis. 2016; 41: 384-393
- Platelet activation due to hemodynamic shear stresses: damage accumulation model and comparison to in vitro measurements.ASAIO J. 2008; 54: 64-72
- Prothrombin fragments in cardiovascular disease.Adv. Clin. Chem. 2010; 51: 1-23
- P-selectin and platelet clearance.Blood. 1998; 92: 4446-4452
- Platelet activation after sorin freedom solo valve implantation: a comparative study with Carpentier-Edwards Perimount Magna.J. Heart Valve Dis. 2014; 23: 777-782
- Human platelet factor 4 and its C-terminal peptides: heparin binding and clearance from the circulation.Thromb. Haemost. 1990; 63: 493-498
- Production of soluble P-selectin by platelets and endothelial cells.Biochemistry (Mosc). 1999; 64: 1326-1335
- Hypothesis: is soluble P-selectin a new marker of platelet activation?.Atherosclerosis. 1997; 128: 135-138
- Soluble P-selectin in atherosclerosis: a comparison with endothelial cell and platelet markers.Thromb. Haemost. 1997; 77: 1077-1080
- Effects of heparin and aspirin on circulating P-selectin, E-selectin and von Willebrand factor levels in healthy men.Atherosclerosis. 2001; 155: 389-393
- Hypercoagulable states in cardiovascular disease.Circulation. 2008; 118: 2286-2297
Article info
Publication history
Published online: May 26, 2017
Accepted:
May 21,
2017
Received in revised form:
May 18,
2017
Received:
November 3,
2016
Identification
Copyright
© 2017 Elsevier Ltd. All rights reserved.