Occurrence and clinical significance of in-hospital acquired thrombocytopenia in patients undergoing transcatheter device closure for congenital heart defect

Background: Acquired thrombocytopenia in patients treated by percutaneous coronary intervention is associated with hemorrhagic complications and prolonged in-hospital stay. This study sought to study the prevalence of thrombocytopenia in patients who underwent transcatheter device closure for congenital heart defect (CHD) and its relationship with clinical consequences.

Methods and results: 299 patients with CHD who underwent successful transcatheter closure were prospectively studied. Thrombocytopenia developed in 135 (45.2%) patients; n=100 (33.4%) mild (100-150 × 10(9)/L), n=25 (8.4%) moderate (50-100 × 10(9)/L), and n=10 (3.3%) severe (P<50 × 10(9)/L), respectively. From baseline, platelet counts tended to decrease on the 1st day after the procedure and reached a nadir level on the 3rd day, then gradually recovered to baseline values on the 9th day. By multivariate analysis, severe thrombocytopenia developed more frequently in patients who had larger device size (OR 2.755, P=0.000), and residue shunt (OR 2.069, P=0.009). Patients who developed thrombocytopenia, compared with those who did not, had higher in-hospital rates of hemorrhagic complications (11.9% vs. 3.0%, P<0.003), greater requirement for elevating platelet medical treatment or platelet transfusion (4.4% vs. 0, P=0.021), longer hospital stay (median 14 vs. 9 days, P<0.001). Severe thrombocytopenia was an independent predictor of hemorrhagic complications (hazard ratio 8.083, 95% CI 4.021-16.237, P=0.001). Compare with patients without thrombocytopenia, bleeding events were markedly increased (11.9% vs. 3.0%, P=0.003) in those with thrombocytopenia during hospitalization.

Conclusion: The size of occluder and other risk factors are independently associated with thrombocytopenia. Thrombocytopenia provides prognostic information, related to increased bleeding events.