自膨式经导管主动脉瓣置换术后血小板减少症的预测因素：来自中国的单中心经验
Predictors of Thrombocytopenia after Self-Expandable Transcatheter Aortic Valve Replacement: A Single-Center Experience from China.
作者信息
Zhu Qifeng, Liu Xianbao, He Wei, He Yuxin, Tang Mengyao, Sun Yinghao, Xu Xiaobin, Shi Keda, Kong Huijia, Jiang Jubo, Chen Liangwei, Chen Jie, Hu Po, Xu Qiyuan, Wang Jianan
机构信息
Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
出版信息
Cardiology. 2018;139(3):151-158. doi: 10.1159/000484627. Epub 2018 Jan 20.
OBJECTIVES
The importance of thrombocytopenia (TP) has been discussed previously. However, data are still limited, especially on predictors of TP. We sought to investigate predictors of TP after transcatheter aortic valve replacement (TAVR), in particular, clinically significant TP.
METHODS
We reviewed a total of 123 consecutive patients undergoing TAVR in our medical center. They were stratified into 3 groups according to the nadir platelet count post-TAVR: no/mild TP, moderate TP, and severe TP. Clinically significant TP, also known as major TP, was defined as moderate-to-severe TP (a nadir platelet count <100 × 109/L and a >50% decrease in platelet count).
RESULTS
Baseline platelet, baseline hemoglobin, general anesthesia (GA), valve malpositioning and post-TAVR left ventricular ejection fraction were found to be predictors of post-TAVR nadir platelet count. Major TP was associated with a higher risk of major bleeding (OR 3.524, 95% CI 1.546-8.031) and 1-month mortality (OR 11.226, 95% CI 1.208-104.328). Age (OR 1.110, 95% CI 1.014-1.215) and GA (OR 6.494, 95% CI 2.058-20.408) were predictors of major TP.
CONCLUSION
Post-TAVR nadir platelet count can be predicted based on baseline and procedural data. Old age and GA contribute to clinically significant TP.
目的
先前已讨论过血小板减少症（TP）的重要性。然而，数据仍然有限，尤其是关于TP的预测因素。我们试图研究经导管主动脉瓣置换术（TAVR）后TP的预测因素，特别是具有临床意义的TP。
方法
我们回顾了在我们医疗中心连续接受TAVR的123例患者。根据TAVR后血小板计数最低点将他们分为3组：无/轻度TP、中度TP和重度TP。具有临床意义的TP，也称为严重TP，定义为中度至重度TP（血小板计数最低点<100×10⁹/L且血小板计数下降>50%）。
结果
发现基线血小板、基线血红蛋白、全身麻醉（GA）、瓣膜位置异常和TAVR后左心室射血分数是TAVR后血小板计数最低点的预测因素。严重TP与大出血风险较高（OR 3.524，95%CI 1.546 - 8.031）和1个月死亡率较高（OR 11.226，95%CI 1.208 - 104.328）相关。年龄（OR 1.110，95%CI 1.014 - 1.215）和GA（OR 6.
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