Telila Tesfaye, Akintoye Emmanuel, Ando Tomo, Merid Obsinet, Mallikethi-Reddy Sagar, Briasoulis Alexandros, Grines Cindy, Afonso Luis
Division of Cardiology, Wayne State University, Detroit Medical Center, Detroit, Michigan.
Division of Internal Medicine, Detroit Medical Center, Detroit, Michigan.
Am J Cardiol. 2017 Jul 15;120(2):300-303. doi: 10.1016/j.amjcard.2017.04.028. Epub 2017 Apr 27.
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.
本研究的主要目的是调查肝素诱导的血小板减少症（HIT）对接受经导管主动脉瓣置换术（TAVR）患者预后的发生率及影响程度。HIT对心脏手术后手术预后的影响已有相关描述。我们试图利用全国住院患者样本（NIS）数据库调查TAVR术后HIT的发生率及预后情况。我们确定了2011年至2014年期间接受TAVR的患者。主要结局是HIT对住院死亡率的影响。次要结局包括围手术期血栓栓塞并发症及后续后遗症。我们还检查了住院时间和住院费用。分层混合效应模型检验了HIT与主要结局之间的关联，并根据患者和医院层面的特征进行了调整。在33790例接受TAVR的患者中（46.1%为女性，年龄81.4±8.5岁），HIT的累积发生率为0.49%（95%CI 0.4%至0.6%）。在对患者和医院层面的特征进行调整后，发生HIT的TAVR组患者的院内死亡率显著更高（比值比[OR]5.6，95%CI 2.0至15.6，p = 0.001）。静脉血栓形成/肺栓塞（OR 6.3，95%CI 1.4至28.8，p = 0.01）和急性肾损伤（OR 6.1，95%CI 2.8至13.1，p<0.001）与HIT显著相关。发生HIT的患者住院时间也更长（p<0.001），住院费用中位数为68168美元，而未发生HIT的组为50494美元（p<0.001）。总之，在接受TAVR的患者中，HIT与更高的院内死亡风险、静脉血栓形成/肺栓塞、急性肾损伤、住院时间延长及费用增加相关。
