A Simple Clinical Pre-procedure Risk Model for Predicting Thrombocytopenia Associated With Periprocedural Use of Tirofiban in Patients Undergoing Percutaneous Coronary Intervention

Abstract

Background: No risk model for predicting thrombocytopenia associated with periprocedural tirofiban exposure is available. The purpose of this study was to develop a simple clinical pre-procedure risk model based on pre-procedural characteristics for early prediction of thrombocytopenia before patients were exposed to tirofiban.Methods: The series included 1862 patients who underwent percutaneous coronary intervention with tirofiban exposure. Baseline demographic and clinical characteristics were collected from the hospital information system on admission. The earliest pro-procedural platelets within 72 h were used to evaluate the thrombocytopenia incidence. Risk factors associated with thrombocytopenia in patients with tirofiban exposure were investigated by univariable and multivariable analyses. Locally weighted scatterplot smoothing procedure was used to identify the cut points for the numeric variables. The discriminatory power of the scoring system was assessed with the receiver operating characteristic (ROC) curve analysis.Results: The occurrence of thrombocytopenia was 4.02% (75 of 1862), 4.01% (56 of 1396), and 4.08% (19 of 466) in the overall, developmental, and validation data sets, respectively. The risk score was developed based on five independent predictors: age ≥65y, white blood cell ≥12 × 109/L, diabetes mellitus, congestive heart failure, and chronic kidney disease. This tool was well calibrated (Hosmer Lemeshow χ2 = 6.914; P = 0.546) and good discrimination was well obtained in validation data set (C-statistic, 0.82).Conclusion: The clinical pre-procedure risk model is a simple and accurate tool for early identification of high-risk patients of thrombocytopenia before tirofiban exposure, allowing for timely and appropriate intervention.

Mean Platelet Volume: A Possible Predictor for Patients with Decompensated Chronic Heart Failure

“…This could be a possible explanation of why patients with increased MPV, even if they are being treated with antiplatelet drugs, have a more severe progression, with more frequent rehospitalizations and a higher death rate. 28 , 29 …”

Severe thrombocytopenia induced by tirofiban after percutaneous coronary intervention: a case report

“…It inhibits platelet aggregation by preventing the attachment of fibrinogen and von Willebrand factor to the GP IIb/IIIa receptor on the thrombocyte surface [ 6 ]. While the usage of GP IIb/IIIa inhibitors sets an important clinical benefit, the reported incidence of thrombocytopenia induced by tirofiban ranges from 0.4% to 5.6% [ 7 ]. Thus, clinicians should be particularly aware of tirofiban-induced thrombocytopenia in routine practice.…”

“…Type I HIT is a transient, mild drop in platelet counts 48–72 hours after initiation of heparin therapy. It occurs because of direct heparin-induced platelet aggregation and is usually clinically harmless [ 7 ]. Type II HIT is an adverse immune-mediated reaction due to antibodies formed against heparin–platelet factor 4 complexes, which is usually associated with thrombosis risk.…”

“…A recent study based on pre-procedural characteristics for early prediction of thrombocytopenia before patients were exposed to tirofiban has developed a simple risk model to predict thrombocytopenia associated with periprocedural tirofiban exposure [ 7 ]. Five independent risk factors, including age ≥ 65 years (2 points), white blood cell ≥ 12 × 10 9 /L (1 point), diabetes mellitus (2 points), congestive heart failure (2 points), and chronic kidney disease (1 point), were identified as risk factors in the scoring system.…”

“…For our patient, this score only indicates a moderate risk (4 points), calculated based on age and congestive heart failure. Therefore, a further predictive model is still needed to help doctors identify high-risk patients in clinical practice [ 7 ].…”