Antiplatelet therapy for patients with stable ischemic heart disease and baseline thrombocytopenia: Ask the hematologist

Effects of Baseline Thrombocytopenia on In-hospital Outcomes in Patients Undergoing Elective Percutaneous Coronary Intervention

Objective The purpose of the present study was to examine the relationship between thrombocytopenia at baseline and in-hospital outcomes in unselected patients undergoing elective percutaneous coronary intervention (PCI) in Japan. Methods Among a total of 1,247 consecutive elective PCI-treated patients, patients with a baseline platelet count 150,000-449,000/μL and 50,000-149,000/μL were assigned to the normal platelet (n=1,009) and thrombocytopenia (n=226) groups, respectively. The thrombocytopenia group was further divided into the mild thrombocytopenia (100,000-149,000/μL, n=187) and moderate thrombocytopenia (50,000-99,000/μL, n=39) groups. Results The angiographic success rate of PCI and in-hospital mortality rate did not differ to a statistically significant extent between the normal platelet and thrombocytopenia groups or between the mild thrombocytopenia and moderate thrombocytopenia groups, whereas the moderate thrombocytopenia group had a significantly higher rate of access site-related bleeding complications than the normal platelet group. According to a multivariate analysis, moderate thrombocytopenia was an independent predictor of access site-related bleeding complications. Conclusion Among patients with mild to moderate thrombocytopenia, elective PCI might be feasible and effective in the short term; however, more attention should be paid to access site-related bleeding complications, particularly in patients with moderate thrombocytopenia.

Impact of baseline thrombocytopenia on the long-term outcome of patients undergoing elective percutaneous coronary intervention: An analysis of 9,897 consecutive patients

OBJECTIVES

This study aimed to investigate the association between baseline thrombocytopenia and long-term clinical outcomes among patients undergoing elective percutaneous coronary intervention (PCI).

BACKGROUND

Thrombocytopenia (TP) commonly occurs among patients undergoing PCI. However, whether TP has any influence on the outcome of PCI patients remains controversial.

METHODS

We examined 9,897 consecutive patients who underwent elective PCI in Fuwai Hospital from January 2013 to December 2013. Baseline thrombocytopenia was defined as platelet count <150 × 10⁹ /L. We compared data on demographic, clinical, laboratory, and 30-month outcomes between nonthrombocytopenic and thrombocytopenic patients. The primary outcome was death and major adverse cardiovascular events (MACE) during the 30-month follow-up. Logistic regression analyses were performed to identify risk factors of baseline thrombocytopenia.

RESULTS

Baseline thrombocytopenia developed in 1263 (12.76%) patients; of these, 1,172 (11.84%) patients had mild thrombocytopenia and 91 (0.92%) had the moderate or severe type. No differences in all-cause mortality, stent thrombosis, target vessel revascularization, MACE, or bleeding complications were detected between patients with and without thrombocytopenia. Further, advanced age, male sex, previous PCI history, previous myocardial infarction history, and diabetes mellitus history were found to be risk factors of baseline thrombocytopenia.

CONCLUSIONS

Although baseline thrombocytopenia was common among patients who underwent elective PCI, it did not appear to have a clinically significant effect on long-term adverse outcomes, particular bleeding risk. Our results indicated that it seems to be feasible for patients with mild to moderate thrombocytopenia to receive elective PCI as well as guideline-recommended duration of anti-platelet therapy.

Left main crossover stenting in a patient with severe thrombocytopenia due to aplastic anemia

A 76-year-old man with aplastic anemia presented with recurrent acute myocardial infarction (AMI) with heart failure. After the initial appearance of AMI approximately 2 months earlier, he had received conservative treatment/transfusion alone because of severe thrombocytopenia and anemia (platelet 11 × 10³/μL, hemoglobin 6.4 g/dL). Refractory heart failure persisted despite repeated conservative treatment/transfusion for the second AMI, and therefore, we performed transradial coronary angiography and left main crossover stenting with a bare metal stent. His critical condition markedly improved; however, soon after discharge, he complicated with subdural hematoma. He has since been free of cardiovascular/hemorrhagic events for 7 months without antiplatelet/anticoagulant therapy.