Pre-operative platelet reactivity is a strong, independent predictor of bleeding complications after branched endovascular thoracoabdominal aortic aneurysm repair

Abstract

Endovascular aortic repair (EVAR) an alternative to open surgical repair of thoracoabdominal aortic aneurysm (TAAA). The effect of EVAR on platelet reactivity is unknown. We prospectively determined the effect of branched EVAR (bEVAR) on platelet reactivity in patients with TAAA, and evaluated the predictive value of preoperative platelet reactivity for post-operative bleeding in 50 consecutive patients undergoing elective bEVAR (mean age 70.9 ± 5.7 years, 66% male). Blood samples were collected within 24 hours before bEVAR, after bEVAR and at hospital discharge. Platelet reactivity was assessed with impedance aggregometry using ASPI, ADP and TRAP tests. Platelet reactivity decreased within 24 hours after bEVAR compared to the measurement before bEVAR in all tests (p ≤ 0.04), with a further decrease in hospital discharge in the ADP test (p = .004). Twenty-three patients experienced post-operative bleeding complications (transfusion ≥2 red blood cell [RBC] units). Preoperative platelet reactivity below the cutoff value of 30 AUC units predicted post-operative bleeding with 78% sensitivity and 59% specificity (p = .045). In the multivariable analysis, platelet reactivity was the only independent predictor of postoperative bleeding (OR 6.507, 95% CI 1.227–34.506, p = .028). We conclude that platelet reactivity decreases following bEVAR of TAAA and is a strong and independent predictor for postoperative bleeding complications.

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© The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group

Keywords:

• aortic aneurysm
• bleeding
• EVAR
• platelet reactivity
• risk stratification

Author contributions

Conceptualization, A. Gasecka., M. Zawadka, K.J. Filipiak, T. Jakimowicz; methodology, A. Gasecka, M. Zawadka, K. Jama, T. Jakimowicz; formal analysis, A. Gasecka; investigation, A. Burban, A. Idzik, A. Gelo, A. Graczyńska; resources, A. Gąsecka, K. Jama, T. Jakimowicz; writing—original draft preparation, A. Gasecka.; writing—review, and editing, M. Zawadka, K. J. Filipiak, T. Jakimowicz; supervision, K. J. Filipiak, T. Jakimowicz; project administration, A. Burban, A. Idzik, A. Gelo, A. Graczyńska. All authors have read and agreed to the published version of the manuscript.

Data availability statement:

Source data files are available upon request.

Declaration of interest statement

The authors report no conflict of interest

Institutional review board statement

The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of Medical University of Warsaw (approval number KB/118/2019, date of approval 2 December 2019).

Supplementary material

Supplemental data for this article can be accessed on the publisher’s website.

Additional information

Funding

There was no external funding for this study.