Clinical Implications of Thrombocytopenia Among Patients Undergoing Intra‐aortic Balloon Pump Counterpulsation in the Coronary Care Unit

Abstract

Background: Thrombocytopenia Hypothesis: intra-aortic balloon pump (IABP)-associated thrombocytopenia is not associated with an increased risk of major bleeding or in-hospital death. Thrombocytopenia is a common adverse effect of the IABP. However, the clinical implications of IABP-associated thrombocytopenia are unknown. Methods: We assessed the incidence and predictors of thrombocytopenia, and the association between thrombocytopenia and relevant clinical end points, using prospectively collected data on 252 consecutive patients undergoing IABP in a single coronary care unit (CCU). Results: Anticoagulation with intravenous heparin was administered to 182 patients (72%). Baseline platelet counts were 232 000 ± 96 000 mL, decreased to 154 000 ± 74 000 mL at day 3, and recovered to baseline by day 8. Thrombocytopenia (nadir <150 000 mL or >50% reduction from baseline) occurred in 109 patients (43%), with a similar incidence among patients who received heparin and those who did not (45% vs 40%, P = 0.5). Independent predictors of thrombocytopenia were lower body weight, cardiogenic shock, and duration of IABP support. The incidence of both major bleeding and in-hospital death were higher among patients who developed thrombocytopenia than among those who did not (13.8% vs 4.2%, P = 0.01 and 28% vs 16%, P = 0.02, respectively). However, after controlling for confounding variables, thrombocytopenia was not an independent predictor of either major bleeding (odds ratio [OR]: 2.2, 95% confidence interval [CI]: 0.8-6.4, P = 0.1) or in-hospital death (OR: 1.5, 95% CI: 0.8-2.9, P = 0.3). Conclusions: Among patients undergoing IABP in the CCU, thrombocytopenia is generally mild, appears to be unrelated to concomitant heparin use, and is not associated with an increased risk of major bleeding or in-hospital death.

Pretransplant Coagulopathy and In‐hospital Outcomes Among Heart Transplant Recipients: A Propensity‐Matched Nationwide Inpatient Sample Study

“…This may indicate that coagulopathy that develops from a mechanical source has a lesser impact on bleeding and mortality. This finding is similar to previous studies that showed that thrombocytopenia secondary to IABP insertion was not associated with major bleeding or in‐hospital mortality, suggesting that thrombocytopenia that develops from a mechanical factor may have less clinical significance than thrombocytopenia that develops in a systemic illness . Studies have also shown that pre–cardiac transplant coagulopathy developing after cardiogenic shock is a marker of worse prognosis and increased bleeding and mortality, a finding that was used to support institution of MCS before shock‐induced coagulopathy to reduce risk of bleeding and graft failure.…”

“…This finding is similar to previous studies that showed that thrombocytopenia secondary to IABP insertion was not associated with major bleeding or in-hospital mortality, suggesting that thrombocytopenia that develops from a mechanical factor may have less clinical significance than thrombocytopenia that develops in a systemic illness. 13,35,36 Studies have also shown that pre-cardiac transplant coagulopathy developing after cardiogenic shock is a marker of worse prognosis and increased bleeding and mortality, 17 a finding that was used to support institution of MCS before shock-induced coagulopathy to reduce risk of bleeding and graft failure. However, findings from our subgroup analysis demonstrated a homogenous association of pre-HT coagulopathy and in-hospital mortality, both in patients with and in those without cardiogenic shock.…”

Thrombocytopenia in the Intensive Care Unit

“…A score ≤ 3 suggests a low pre-test probability for HIT, a score 4-5 an intermediate probability, and a score > 5 a high probability severe thrombocytopenia (defined as a platelet count <20 × 10 9 cells/L) vs 16% in the control arm [69]. For patients placed on an intra-aortic balloon pump, roughly 50% will develop thrombocytopenia [70,71].…”

New-onset acute thrombocytopenia in hospitalized patients: pathophysiology and diagnostic approach

“…Platelet drop is usually mild and not associated with clinically significant bleeding. Patients on IABP frequently have concomitant heparin use for anticoagulation but the platelet drop is independent [ 26 ]. Continuous flow ventricular assist devices cause thrombocytopenia by causing platelet activation and aggregation due to non-pulsatile blood flow and mechanical shear stress [ 27 ].…”