An overlooked fact: thrombocytopenia following bioprosthetic aortic valve replacement

Kizilay, Mehmet; Elbir, Ferruh; Aglar, Ahmet Arif; Vural, Ünsal; Balcı, Ahmet; Yekeler, İbrahim

doi:10.5114/kitp.2019.83941

Cited by 9 publications

(14 citation statements)

References 16 publications

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“…Postoperative moderate-severe thrombocytopenia was more common in patients with bioprosthetic aortic valve replacement than in patients with CABG surgery and mechanical aortic valve replacement on the second postoperative day. 20 Similar to this study, we found that the presence of moderate-severe thrombocytopenia in bioprosthetic valves was statistically significantly higher (53.1%, 17/32) compared with patients with mechanical valves (32.6%, 44/135) ( p = 0.030). However, the number of patients with mechanical valves was about four times those with bioprostheses.…”

Section: Discussionsupporting

confidence: 88%

Non-heparin-induced thrombocytopenia in patients after open-heart surgery

Keleş¹,

Bilen²,

Aygün³

et al. 2022

Perfusion

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Background Thrombocytopenia (platelet count below 150 x 103/μL) is a common finding after open-heart surgery and can lead to various complications, including patient death. This study aimed to determine the extent of non–heparin-induced thrombocytopenia in open-heart surgery and to highlight the associated factors. Materials and Methods In this cohort study, 842 patients who underwent valve and/or coronary bypass surgery over a 5-year period were retrospectively analyzed. After open-heart surgery, patients whose platelet count was less than 150 x 103/μL on a complete blood count 12 and 24 h after surgery were classified as thrombocytopenic. Three hundred twenty patients without thrombocytopenia and 21 patients with a high probability of heparin-induced thrombocytopenia were excluded from the study. Logistic regression analysis was used to assess the association of independent variables in moderate-severe thrombocytopenia: Age groups, sex, underlying disease, symptoms, type of surgery, pump time, pulsatile or non-pulsatile duration, degree of hypothermia, hemodilution, oxygenator type, use of an intra-aortic balloon, and erythrocyte transfusion counts were included in the analysis. Results A total of 501 patients were diagnosed as having non–heparin-induced thrombocytopenia, and 64.3% were male. Three hundred seventy-seven (75.2%) patients had mild thrombocytopenia and 124 (24.7%) had moderate-severe thrombocytopenia. The postoperative platelet count was significantly lower than the preoperative platelet count (213 x 103 vs.117 x 103/μL; p < 0.001). Moderate-severe thrombocytopenia was associated with age ≥80 years odds (OR = 9.026, 95% CI: [1.757–46.363]; p = 0.008), isolated valve surgery (OR = 3.090, 95% CI: [1.867–5.114]; p < 0.001), and valve surgery with coronary bypass (OR = 4.938, 95% CI: [1.638–14.889]; p = 0.005) compared to isolated coronary bypass, type of oxygenator (Nipro vital compared with Affinity OR = 11.097, 95% CI: [1.923–64.023]; p = 0.007), erythrocyte transfusion count (OR = 1.219, 95%CI: [1.046–1.420]; p = 0.011). Conclusion Age 80 years or older, surgical procedures including heart-valve surgery, and the number of red blood cell transfusions are associated with the risk of moderate-to-severe thrombocytopenia. This study provides a guide in terms of risk factors that may lead to moderate-to-severe thrombocytopenia after open-heart surgery. However, future multicentre prospective randomized studies may provide more detailed information on this subject.

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Section: Discussionsupporting

confidence: 88%

Non-heparin-induced thrombocytopenia in patients after open-heart surgery

Keleş¹,

Bilen²,

Aygün³

et al. 2022

Perfusion

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“…Disturbance of thrombopoiesis through cytokines or thrombopoietin, antibodies against megakariocytes, platelet activation resulting in microvascular thrombi, organ sequestration or their phagocytosis, as well as cytotoxicity and apoptosis induced by bacterial products may all be involved [ 48 , 49 ]. Confounding causes include heparin-induced thrombocytopenia or transient postoperative thrombocytopenia related to bioprosthetic valves [ 50 ]. In our case the thrombocytopenia, although improved after anticoagulation, resolved only after surgery, likely related to the removal of pathogen source [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

“…Confounding causes include heparin-induced thrombocytopenia or transient postoperative thrombocytopenia related to bioprosthetic valves [ 50 ]. In our case the thrombocytopenia, although improved after anticoagulation, resolved only after surgery, likely related to the removal of pathogen source [ 50 ].…”

Section: Discussionmentioning

confidence: 99%

Frenemies within: An Endocarditis Case in Behçet’s Disease

Moroșan

Șerban

Trifan³

et al. 2021

JPM

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A 57-year female patient diagnosed with Behçet’s disease, on azathioprine, was noticed to have at a routine examination antinuclear and antiphospholipid antibodies. An overlapping lupus-like syndrome was diagnosed; hydroxychloroquine and aspirin were added. Three years later, the patient presented with dyspnea and sweating, with no fever. A cardiac bruit was noted; a giant vegetation was detected by echocardiography. Laboratory revealed severe thrombocytopenia, antiphospholipid antibodies and low complement. Blood cultures were positive for Abiotrophia defectiva serology and also revealed a chronic Coxiella burnetii infection. Antibiotic therapy, low-dose anticoagulation and control of the underlying disease mildly improved the platelet count, which fully recovered only after cardiac valve replacement. However, the Behçet’s disease, initially quiescent, flared after the therapy of infections. We discuss potential links between Behçet’s disease and the occurrence of antinuclear and antiphospholipid antibodies and Coxiella endocarditis in this setting. We also highlight the differences between the endocarditis in Behçet’s disease, antiphospholipid syndrome, Coxiella burnetii and Abiotrophia defectiva infection, respectively. Intracellular infections may modify the presentation of autoimmune diseases. Confounding clinical features of Coxiella persistent infection and non-bacterial thrombotic endocarditis in Behçet’s disease warrant further insight.

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“…Extensive research of the scientific literature revealed limited information regarding cases of patients with heart valve prostheses and associated thrombocytopenia. The few existing reports presented the appearance within the immediate time span after the surgical or interventional procedure (6)(7)(8). Related to the thrombocytopenia causes, studies present numerous and varied conditions that can trigger it.…”

Section: Discussionmentioning

confidence: 99%

Heart valve mechanical prosthesis: The perfect match until it is not - A case report

Movileanu¹,

Pepa²,

Cândea

et al. 2020

Exp Ther Med

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Primary immune thrombocytopenia (ITP), formerly known as idiopathic thrombocytopenia, is defined by a reduced platelet count <50x10 9 and is clinically manifested through signs and symptoms such as bleeding, ecchymosis and petechiae. Its coexistence with the implantation of the mechanical valves and the necessity of anticoagulation creates an additional risk of bleeding. Although mechanical valves are indispensable in prolonging and improving the quality of life in patients with valvular heart disease, in the context of an additional bleeding risk factor, their presence could represent a threat to life exposing the patient to major complications and leading to death. The purpose of this case report is to discuss the disadvantages and possible fatal complications of the association between mechanical valves and severe thrombocytopenia. A possible solution to these downsides could be found in the future search in regenerative medicine and tissue engineering of heart valves resulting in products that do not require anticoagulation and do not pose a threat to patients with thrombocytopenia.

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An overlooked fact: thrombocytopenia following bioprosthetic aortic valve replacement

Cited by 9 publications

References 16 publications

Non-heparin-induced thrombocytopenia in patients after open-heart surgery

Non-heparin-induced thrombocytopenia in patients after open-heart surgery

Frenemies within: An Endocarditis Case in Behçet’s Disease

Heart valve mechanical prosthesis: The perfect match until it is not - A case report

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