Decline in platelet count in patients treated by percutaneous coronary intervention: definition, incidence, prognostic importance, and predictive factors.
ABSTRACT We investigated the incidence, predictors, and prognostic impact of a decline in platelet count (DPC) in patients treated by percutaneous coronary intervention (PCI).
A total of 10 146 consecutive patients treated by PCI from 2003 to 2006 were included. According to the magnitude of the DPC, the population was divided into four groups: no DPC (<10%), minor DPC (10-24%), moderate DPC (25-49%), and severe DPC (>or=50%). The primary haemorrhagic endpoint was a composite of post-procedure surgical repair major bleeding. The primary ischaemic endpoint was 30-day all-cause mortality-non-fatal myocardial infarction. Among the total population, 36% had a DPC <10%, 47.7% had a DPC of 10-24%, 14% had a DPC of 25-49%, and 2.3% had a DPC >or=50%. On multivariate analysis, moderate and severe DPC were independent predictive factors of the ischaemic outcome. Two procedural practices were identified that, if modified, might reduce the incidence of acquired thrombocytopaenia. Both the intraprocedural use of heparin (as opposed to bivalirudin) and of low molecular weight contrast material were independently associated with severe acquired thrombocytopaenia.
Moderate and severe DPC are independent predictors of adverse bleeding and ischaemic outcomes in PCI. Adoption of intraprocedural anticoagulant other than heparin and avoidance of a low molecular weight contrast agent could potentially decrease the occurrence of severe acquired thrombocytopaenia.
- [Show abstract] [Hide abstract]
ABSTRACT: It is unclear whether platelet count (PLT) is independently associated with clinical outcome in patients with acute coronary syndrome (ACS). MEDLINE, EMBASE, the Cochrane library clinical trials registry, ISI Science Citation Index, and ISI Web of Knowledge were searched, supplemented by hand-scanning of references of relevant publications and contacting content experts. Eight studies including 39,324 patients were identified that addressed the following issues: major adverse cardiac events (MACE) and mortality were defined as endpoints; the relative risk (RR) or relative odds and their variance with MACE associated with PLT; studies in which only PLT was quantified. Two investigators independently abstracted information on study design, study and participant characteristics, PLT, clinical outcomes, control for potential confounding factors and risk estimates using a standardized protocol. At 1-month follow-up, compared with the bottom PLT group (< 150 × 10(9)/L), the pooled RRs of mortality and MACE were 1.78 (P=0.14) and 1.63 (P<0.001) for the upper PLT (> 350 × 10(9)/L), respectively. At long-term follow-up (≥ 1 year), the pooled RRs of mortality and MACE were 1.48 (P=0.02) and 1.28 (P=0.02) for the upper PLT, respectively. Moreover, the pooled RR of longitudinal mortality was 1.024 (P=0.03) when PLT was used as a continuous variable. Higher PLT at baseline increases the RR of mortality and MACE in ACS patients.Circulation Journal 02/2012; 76(3):704-11. · 3.58 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Thrombocytopenia is often regarded as a risk factor for bleeding complications in patients undergoing percutaneous coronary intervention (PCI). The risk of mild to moderate baseline and acquired thrombocytopenia on bleeding and thrombotic or thromboembolic complications in patients with atrial fibrillation on oral anticoagulation therapy undergoing PCI, however, remains largely unknown. Management of Patients With Atrial Fibrillation undergoing Coronary Artery Stenting is a multicenter European prospective registry enrolling patients with atrial fibrillation undergoing PCI. We assessed the rate of bleeding complications as defined by Bleeding Academic Research Consortium and a composite of major adverse cardiac and cerebrovascular events (MACCE) including all-cause mortality, myocardial infarction, transient ischemic attack or stroke, stent thrombosis, systemic arterial embolism, or revascularization; and a composite of any harmful event (Bleeding Academic Research Consortium and MACCE) at 12-month follow-up in 861 consecutive patients undergoing PCI. Patients were divided into those with mild to moderate baseline thrombocytopenia (platelet count <150 × 10(9)/L; n = 99) and control group (platelet count >150 × 10(9)/L; n = 762). At hospital discharge, thrombocytopenia had no effect on prescribed antithrombotic treatment, and triple therapy (vitamin K antagonist + aspirin + clopidogrel) was the most common combination in both patient groups (69% vs 73%, p = 0.40). No differences in all-cause mortality (12% vs 11%, p = 0.79), MACCE (23% vs 22%, p = 0.87), or bleeding complications (23% vs 19%, p = 0.26) were detected. Acquired in-hospital thrombocytopenia occurred in 9.7% of patients, and it was associated with similar risk of adverse outcomes compared with control group. In conclusion, mild to moderate baseline thrombocytopenia does not seem to have a clinically significant effect on bleeding or thrombotic or thromboembolic complications after PCI in these frail patients receiving multiple antithrombotic drugs.The American journal of cardiology 05/2013; · 3.58 Impact Factor
- [Show abstract] [Hide abstract]
ABSTRACT: Thrombocytopenia (TC) following a percutaneous coronary intervention (PCI) has been associated not only with hemorrhagic, but also with ischemic outcomes. The purpose of this study was to re-examine the relationship of TC with ischemic events at a 1-year follow-up, and investigate the possible associations. Methods and Results We studied a real-world, unselected population of ischemic patients undergoing PCI, totaling 861 patients-year, and divided into two groups: with TC (delta platelet count ≥25% from baseline to post-PCI during the hospital admission) and without TC. Compared with patients without TC, patients with TC had a higher and earlier incidence of both hemorrhagic and ischemic events. In them, the use of intra-aortic balloon pump (IABP) was ten-fold higher. In Kaplan-Meier curves assessing the contribution of both TC and IABP to oucome, IABP was an univariate detrimental factor additive to the role of TC. In a forced Cox model, the relative decline (delta) in platelet count (p=0.05) and the use of IABP (p=0.0001) were both associated with ischemic outcomes. After excluding all patients with IABP, the delta platelet count was no longer significantly associated with ischemic outcomes (p=0.66). After excluding all patients with shock and all those undergone thrombolysis, there was still a relationship (p=0.0042) between the delta platelet count and ischemic events. In this patient population the use of IABP, but not thrombocytopenia per se, is a possible primary cause of worse ischemic outcomes.Vascular Pharmacology 11/2013; · 3.21 Impact Factor