Coronary artery diseaseImpact of In-Hospital Acquired Thrombocytopenia in Patients Undergoing Primary Angioplasty for Acute Myocardial Infarction
Section snippets
Patient population and study design
In the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial, 2,082 patients of any age who developed AMI within 12 hours of onset and underwent primary PCI in a native coronary artery that was eligible for stent implantation were randomized to 1 of 4 mechanical reperfusion strategies: percutaneous transluminal coronary balloon angioplasty with or without abciximab (Centocor, Malvern, Pennsylvania) versus stenting with the Multilink stent
Incidence of acquired thrombocytopenia after primary angioplasty
Of the 2,082 randomized patients, 1,975 (94.8%) had a platelet count >100 × 109/L on admission and ≥2 measured values after PCI. From this group, 50 patients (2.5%) developed thrombocytopenia before hospital discharge. Among these patients, the median platelet count decreased from 179 × 109/L (interquartile range 144 to 228) to 84 × 109/L (interquartile range 50 to 93, p < 0.0001). Thrombocytopenia was classified as mild in 36 patients (72%), severe in 12 patients (24%), and profound in 2
Discussion
The major results of this report are: (1) thrombocytopenia that developed after hospital admission occurred in 2.5% of patients who underwent contemporary mechanical reperfusion strategies for AMI; (2) the occurrence of thrombocytopenia was most strongly predicted by non-insulin-requiring diabetes mellitus, use of statin medications before admission, lower body mass index, lower platelet count at admission, and treatment with abciximab; (3) development of thrombocytopenia was associated with
References (20)
- et al.
Occurrence and clinical significance of thrombocytopenia in a population undergoing high-risk percutaneous coronary revascularization. Evaluation of c7E3 for the Prevention of Ischemic Complications (EPIC) Study Group
J Am Coll Cardiol
(1998) - et al.
Thrombocytopenia complicating treatment with intravenous glycoprotein IIb/IIIa receptor inhibitorsa pooled analysis
Am Heart J
(2000) - et al.
Clinical correlates and course of thrombocytopenia during percutaneous coronary intervention in the era of abciximab platelet glycoprotein IIb/IIIa blockade
Am Heart J
(2000) - et al.
Clinical importance of thrombocytopenia occurring in the hospital phase after administration of thrombolytic therapy for acute myocardial infarction. The Thrombolysis and Angioplasty in Myocardial Infarction Study Group
J Am Coll Cardiol
(1994) - et al.
Thrombotic thrombocytopenic purpura and simvastatin
Lancet
(1998) Platelet glycoprotein IIb/IIIa receptor blockade and low-dose heparin during percutaneous coronary revascularization
N Engl J Med
(1997)Randomised placebo-controlled and balloon-angioplasty-controlled trial to assess safety of coronary stenting with use of platelet glycoprotein-IIb/IIIa blockade. Evaluation of Platelet IIb/IIIa Inhibitor for Stenting
Lancet
(1998)- et al.
Hemorrhagic events during therapy with recombinant tissue-type plasminogen activator, heparin, and aspirin for acute myocardial infarction. Results of the Thrombolysis in Myocardial Infarction (TIMI), Phase II Trial
Ann Intern Med
(1991) - et al.
Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction. The Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) Investigators
N Engl J Med
(2002) - et al.
Cost-effectiveness of coronary stenting in acute myocardial infarctionresults from the stent primary angioplasty in myocardial infarction (Stent-PAMI) trial
Circulation
(2001)
Cited by (62)
Impact of Acquired Thrombocytopenia on Cardiovascular Outcomes in Patients With Coronary Artery Disease Undergoing Percutaneous Coronary Intervention: A Systematic Review and Meta-Analysis
2021, Cardiovascular Revascularization MedicineCitation Excerpt :The primary goal of our study was to evaluate the outcomes in nTP versus aTP populations and report the effects for in-hospital, 30-day follow up and the outcomes reported at longest follow up. These outcomes were defined as follows: aTP after PCI was defined as a decline in absolute platelet count to <150 × 109/L [16,19,20], or a >50% decline from the baseline platelet count or a decline to <100 × 109/L in some studies [15,17,18,21]. Baseline thrombocytopenia was defined as a platelet count of <150,000 in CAD patients on presentation to the hospital.
The effect of in-hospital acquired thrombocytopenia on the outcome of patients with acute coronary syndromes: A systematic review and meta-analysis
2016, Thrombosis ResearchCitation Excerpt :After analysis was restricted to four studies [9,20,21,25] using a platelet cut-off value of 80 or 100 × 109/L, no heterogeneity was detected (I2 = 0) and the association between acquired TP and mortality risk persisted (OR[95% CI]: 2.81[1.95–4.03]). Definition of major bleeding also varied across studies with five studies using the GUSTO definition for moderate (requiring blood transfusion but not causing hemodynamic compromise) or severe bleeding (intracranial or causing severe hemodynamic compromise) [8,11,20,21,25], four studies using other composite definitions [9,19,22,27] and one study using a bleeding index to estimate blood loss [24]. Irrespective of the definition used, acquired TP following management for an acute coronary syndrome is associated with a higher risk of major bleeding events (OR[95% CI]: 6.93[5.13–9.38], I2 = 88%) (Fig. 2c).
The role of Glycoprotein IIb/IIIa inhibitors in acute coronary syndromes and the interference with anemia
2016, International Journal of CardiologyPostprocedural anticoagulation for specific therapeutic indications after revascularization for ST-segment elevation myocardial infarction (from the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction Trial)
2014, American Journal of CardiologyCitation Excerpt :In this regard, AC-induced major bleeding (most of which occurred within the first 5 days after procedure) may have led to early discontinuation of antiplatelet therapy, which in the present and previous studies has been strongly linked to ischemic events and death after primary PCI.16,17 In-hospital acquired thrombocytopenia also developed more frequently in the specific indication AC group and has also been strongly associated with subsequent recurrent ischemic and hemorrhagic events.18–20 In terms of specific pharmacotherapy, post-PCI AC with unfractionated heparin was associated with significantly higher rates of 30-day adverse ischemic and hemorrhagic events compared with other agents.