Mitrosz Maciej, Kazimierczyk Remigiusz, Chlabicz Malgorzata, Sobkowicz Bozena, Waszkiewicz Ewa, Lisowska Anna, Dobrzycki Slawomir, Musial Wlodzimierz J, Hirnle Tomasz, Kaminski Karol A, Tycinska Agnieszka M
Department of Cardiac Surgery, Medical University of Bialystok, Poland.
Department of Cardiology, Medical University of Bialystok, Poland.
Adv Med Sci. 2018 Mar;63(1):179-184. doi: 10.1016/j.advms.2017.11.001. Epub 2017 Nov 13.
To determine the time point at which thrombocytopenia after TAVI procedure is an indicator of the worst prognosis, with special consideration of perioperative platelet and coagulation activation as its potential causes.
Thirty two patients (mean age 78.5±7.9years, 62% females) qualified for TAVI procedure were prospectively evaluated. Platelet counts were assessed at baseline and for the next three postoperative (POD) days. Platelet activation was evaluated by P-selectin (PS, serum, ELISA) and platelet factor 4 (PF-4, CTAD plasma), and blood coagulation activation by prothrombin fragments 1+2 (F1+2, plasma, ELISA). Composite end point (CEP) including death and the need of cardiovascular rehospitalization was assessed after a mean of 14.1±6.7months.
During the follow up period half of the patients reached CEP. Thrombocytopenia was more profound and frequent in patients with CEP as compared to those without (p<0.05). No differences regarding either the biomarkers of platelet (PS, PF-4) or coagulation (F1+F2) activation between the groups with and without CEP were found. Patients with moderate-to-severe thrombocytopenia at baseline had worse prognosis (log-rank test, p=0.0003). Based on the receiver operating characteristic curve analysis, the differences between platelet count on each postoperative day and the baseline count did not have any predictive value in CEP occurrence.
Patients with thrombocytopenia following TAVI procedure have poor prognosis, however, the changes on the particular days are not more important than initial platelet count. Further studies are needed to evaluate platelet and blood coagulation activation as potential causes of thrombocytopenia and impaired prognosis related to it.
确定经导管主动脉瓣置入术（TAVI）后血小板减少成为预后最差指标的时间点，并特别考虑围手术期血小板和凝血激活作为其潜在原因。
对32例符合TAVI手术条件的患者（平均年龄78.5±7.9岁，62%为女性）进行前瞻性评估。在基线及术后接下来的三天评估血小板计数。通过P-选择素（PS，血清，酶联免疫吸附测定）和血小板因子4（PF-4，枸橼酸钠-茶碱-腺苷-双嘧达莫血浆）评估血小板激活，通过凝血酶原片段1+2（F1+2，血浆，酶联免疫吸附测定）评估凝血激活。在平均14.1±6.7个月后评估包括死亡和心血管再住院需求的复合终点（CEP）。
在随访期间，一半的患者达到CEP。与未达到CEP的患者相比，CEP患者的血小板减少更严重且更频繁（p<0.05）。在有CEP和无CEP的组之间，未发现血小板（PS、PF-4）或凝血（F1+F2）激活的生物标志物有差异。基线时中度至重度血小板减少的患者预后较差（对数秩检验，p=0.0003）。基于受试者工作特征曲线分析，术后每一天的血小板计数与基线计数之间的差异对CEP的发生没有任何预测价值。
TAVI术后血小板减少的患者预后较差，然而，特定日子的变化不如初始血小板计数重要。需要进一步研究评估血小板和凝血激活作为血小板减少及其相关预后受损的潜在原因。
