Incidence and Outcomes of Heparin-Induced Thrombocytopenia in Patients Undergoing Transcatheter Aortic Valve Replacement.

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Incidence and Outcomes of Heparin-Induced Thrombocytopenia in Patients Undergoing Transcatheter Aortic Valve Replacement.

Am J Cardiol. 2017 Jul 15;120(2):300-303

Authors: Telila T, Akintoye E, Ando T, Merid O, Mallikethi-Reddy S, Briasoulis A, Grines C, Afonso L

Abstract
The main objective of this study was to investigate the incidence and magnitude of impact of heparin-induced thrombocytopenia (HIT) on outcomes of patients undergoing transcatheter aortic valve placement (TAVR). The impact of HIT on procedural outcomes after cardiac surgery has been described. We sought to investigate the incidence and outcomes of HIT after TAVR using the Nationwide Inpatient Sample (NIS) database. We identified patients who underwent TAVR from 2011 to 2014. The primary outcome was the effect of HIT on inpatient mortality. Secondary outcomes included perioperative thromboembolic complications and ensuing sequelae. We also examined the length of hospital stay and hospital cost. Hierarchical mixed-effects models tested the association between HIT and main outcomes, adjusted by patient- and hospital-level characteristics. Among 33,790 patients who underwent TAVR (46.1% women and 81.4 ± 8.5 years old), the cumulative incidence of HIT was 0.49% (95% CI 0.4% to 0.6%). After adjusting for patient- and hospital-level characteristics, in-hospital mortality was significantly higher in the TAVR group with HIT (odds ratio [OR] 5.6, 95% CI 2.0 to 15.6, p = 0.001). Venous thrombosis/pulmonary embolism (OR 6.3, 95% CI 1.4 to 28.8, p = 0.01) and acute kidney injury (OR 6.1, 95% CI 2.8 to 13.1, p <0.001) were significantly associated with HIT. Patients who developed HIT also had a longer hospital stay (p <0.001) with the median hospital cost of 68,168 USD versus 50, 494 USD for the group without HIT (p <0.001). In conclusion, among patient who underwent TAVR, HIT was associated with higher risk of in-hospital mortality, venous thrombosis/pulmonary embolism, acute kidney injury, prolonged hospital stay, and increased cost.

PMID: 28576265 [PubMed - indexed for MEDLINE]

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