Reduced Number of Platelets During Intra-Aortic Balloon Pumping Counterpulsation Predicts Higher Cardiovascular Mortality After Device Removal in Association with Systemic Inflammation

Abstract

Thrombocytopenia is a frequent complication in patients requiring intra-aortic balloon pumping (IABP) counterpulsation. However, its prognostic impact has not been fully addressed. The objective of this study is to evaluate the impact of the change in the platelet number during IABP use on the prognosis after device removal. This is a retrospective observational study. Patients in the intensive cardiac care unit at three Juntendo University hospitals who underwent percutaneous implantation of IABP with or without veno-arterial extracorporeal membrane oxygenation (V-A ECMO), since 2012-2016, were enrolled in the study (n = 439). Patients who died during mechanical circulatory support (n = 47) were excluded. We evaluated the prognostic impact of the ratio of platelet reduction from the baseline (% PLT reduction) during IABP use on cardiovascular mortality after device removal. The median and the range of follow-up period were 298 days and 0-1,869 days, respectively. Unadjusted Kaplan-Meier analysis demonstrated that patients with a higher % PLT reduction had higher cardiovascular (CV) mortality. An adjusted Cox proportional hazard analysis demonstrated that a 10% higher % PLT reduction was associated with higher cardiovascular (CV) mortality (Hazard ratio: 1.3, 95% Confidence interval: 1.1-1.6, P < 0.001). Moreover, % PLT reduction and the maximum C-reactive protein (CRP) level during IABP use were positively correlated (r = 0.326, P < 0.001). The reduced number of platelets during IABP use was associated with an increased risk of CV mortality.

Risk factors and prediction model for thrombocytopenia following coronary artery bypass graft surgery in elderly Chinese population

“…Longer CPB duration and the use of IABP have been associated with an increased risk of thrombocytopenia. Studies have reported varying degrees of PLT dysfunction and reduction associated with IABP use ( 22 , 23 ). These effects may be influenced by factors such as PLT activation, shear stress, PLT adhesion to the IABP surface, and altered blood flow dynamics ( 24 ).…”

One-Year Survival for Developing Acute Kidney Injury in Adult Patients with AMI Cardiogenic Shock Receiving Venoarterial Extracorporeal Membrane Oxygenation

“…Previous studies have shown that decreased PLT count is an important influencing factor for poor prognosis in critically ill patients, patients with cardiovascular disease, and is even strongly associated with the risk of long-term cardiovascular disease. 36 , 37 Existing studies have concluded that during ECMO support therapy, ECMO mechanical support devices, hemodynamic instability, renal failure, infection, and disseminated intravascular coagulation (DIC) can cause a decrease in PLT counts for a variety of reasons. A decrease in PLT counts increases the incidence of bleeding/thrombotic events in patients on ECMO support therapy and is an important influencing factor on the short- and long-term prognosis of patients.…”

PEAL Score to Predict the Mortality Risk of Cardiogenic Shock in the Emergency Department: An Observational Study

“…They proposed that excessive PLT activation may lead to PLT consumption and the further deterioration of coronary ischemia [44]. Moreover, several studies have reported that a reduced number of PLT counts is associated with the increased mortality rate in CS with VA-ECMO and IABP institutions, with the primary mechanism involving mechanical consumption of circulating PLT counts [47][48][49][50][51].…”