Safety of Diagnostic and Therapeutic Cardiac Catheterization in Cancer Patients With Acute Coronary Syndrome and Chronic Thrombocytopenia

Iliescu, Cezar; Balanescu, Dinu Valentin; Donisan, Teodora; Giza, Dana Elena; Gonzalez, Ezequiel D. Muñoz; Çilingiroğlu, Mehmet; Song, Juhee; Mukerji, Siddharth S; Lopez‐Mattei, Juan; Kim, Peter Y.; Palaskas, Nicolas; Mouhayar, Elie; Durand, Jean-Bernard; Marmagkiolis, Konstantinos

doi:10.1016/j.amjcard.2018.07.033

Cited by 39 publications

(30 citation statements)

References 17 publications

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“…15,16 Recent data also suggest that if transradial vascular access is performed, invasive coronary angiography and PCI can be performed safely in cancer patients with chronic thrombocytopenia. 17 Coagulopathy was more prevalent in patients with leukaemia (17.4% vs 4.2%), particularly in patients with AML (29%). This may relate to disseminated intravascular coagulation (DIC) secondary to sepsis, hepatic injury, hepatic toxicity or because of a specific type of AML (acute promyelocytic leukaemia (APL)) 18 whose incidence has been reported as 13% of new AML cases.…”

Section: Discussionmentioning

confidence: 96%

“…However, reassuring data from large cancer centres in the United States suggest that the use of antiplatelets is safe and improves survival in cancer patients with MI and thrombocytopenia, although latest data on newer P2Y12 inhibitors are lacking . Recent data also suggest that if transradial vascular access is performed, invasive coronary angiography and PCI can be performed safely in cancer patients with chronic thrombocytopenia . Coagulopathy was more prevalent in patients with leukaemia (17.4% vs 4.2%), particularly in patients with AML (29%).…”

Section: Discussionmentioning

confidence: 99%

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Management strategies and clinical outcomes of acute myocardial infarction in leukaemia patients: Nationwide insights from United States hospitalisations

et al. 2020

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Summary Background Patients with leukaemia are at increased risk of cardiovascular events. There are limited outcomes data for patients with a history of leukaemia who present with an acute myocardial infarction (AMI). Methods We queried the Nationwide Inpatient Sample (2004‐2014) for patients with a primary discharge diagnosis of AMI, and a concomitant diagnosis of leukaemia, and further stratified according to the subtype of leukaemia. Multivariable logistic regression was conducted to identify the association between leukaemia and major acute cardiovascular and cerebrovascular events (MACCE; composite of mortality, stroke and cardiac complications) and bleeding. Results Out of 6 750 878 AMI admissions, a total of 21 694 patients had a leukaemia diagnosis. The leukaemia group experienced higher rates of MACCE (11.8% vs 7.8%), mortality (10.3% vs 5.8%) and bleeding (5.6% vs 5.3%). Following adjustments, leukaemia was independently associated with increased odds of MACCE (OR 1.26 [1.20, 1.31]) and mortality (OR 1.43 [1.37, 1.50]) without an increased risk of bleeding (OR 0.86 [0.81, 0.92]). Acute myeloid leukaemia (AML) was associated with approximately threefold risk of MACCE (OR 2.81 [2.51, 3.13]) and a fourfold risk of mortality (OR 3.75 [3.34, 4.22]). Patients with leukaemia were less likely to undergo coronary angiography (CA) (48.5% vs 64.5%) and percutaneous coronary intervention (PCI) (28.2% vs 42.9%) compared with those without leukaemia. Conclusion Patients with leukaemia, especially those with AML, are associated with poor clinical outcomes after AMI, and are less likely to receive CA and PCI compared with those without leukaemia. A multi‐disciplinary approach between cardiologists and haematology oncologists may improve the outcomes of patients with leukaemia after AMI.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Management strategies and clinical outcomes of acute myocardial infarction in leukaemia patients: Nationwide insights from United States hospitalisations

et al. 2020

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“…Arterial access was obtained using a modified Seldinger technique with a micropuncture kit. The decision for the access site was based on modified Allen or Barbeau test findings and operator preference (6,20), although radial was preferred over femoral. Vascular Doppler ultrasound was used for most cases of radial access and in femoral access, depending on operator preference.…”

Section: Methodsmentioning

confidence: 99%

“…Approximately 10% of cancer patients have a platelet count of <100,000/mm 3 (5). Causes of chronic thrombocytopenia in cancer patients are multifactorial, but frequently include systemic chemotherapy (6). Although thrombocytopenia is traditionally defined as platelet count <150,000/mm 3 , concern for CA increases as thrombocytopenia increases in severity: mild thrombocytopenia is defined as a platelet count between 50,000-99,999/mm 3 , moderate thrombocytopenia is defined as a platelet count between 20-49,000/mm 3 and severe thrombocytopenia is defined as a platelet count <20,000 mm 3 (7).…”

Section: Introductionmentioning

confidence: 99%

“…Thrombocytopenia has been associated with an increased risk of both ischemic and bleeding complications during CA (8)(9)(10). However, recent experiences with coronary interventions in patients with thrombocytopenia showed encouraging results with respect to safety, suggesting that platelet function could trump absolute platelet counts when assessing procedure-related bleeding risk (6).…”

Section: Introductionmentioning

confidence: 99%

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Identifying Hemostatic Thresholds in Cancer Patients Undergoing Coronary Angiography Based on Platelet Count and Thromboelastography

Agha

Gill

Balanescu

et al. 2020

Front. Cardiovasc. Med.

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Objectives: To evaluate the role of platelet count and thromboelastogram (TEG) in the treatment of thrombocytopenic cancer patients with suspected coronary artery disease (CAD). Background: Cancer patients with CAD and thrombocytopenia are often treated non-invasively (i.e., without coronary angiography when clinically indicated) due to perceived high risk of bleeding. We sought to evaluate coagulability based on TEG and determine if platelet count and TEG could predict bleeding risk/mortality among cancer patients undergoing coronary angiography (CA). Methods: Baseline demographics, platelet count, and TEG parameters were recorded among cancer patients that underwent CA and had a concomitant TEG. Logistic regression and univariate proportional hazards regression analysis were performed to determine the impact of platelet count and coagulability on 24-month overall survival (OS). Results: All patients with platelet count <20,000/mm 3 and nearly all patients with platelet count 20,000-49,000/mm 3 were hypocoagulable based on TEG results. In contrast, nearly all patients with platelet counts of 50,000-99,999/mm 3 had normal TEG results and OS similar to those with platelet counts of ≥100,000/mm 3. Coagulability based on TEG was not associated with OS. However, a platelet count of <50,000/mm 3 was associated with worse 24-month OS (hazard ratio = 2.76; p = 0.0072) when compared with a platelet count of ≥100,000/mm 3. No major bleeding complications were observed in all groups. Conclusion: The majority of cancer patients with platelet counts of <50,000/mm 3 were hypocoagulable based on TEG and had worse OS at 24 months. The relatively Agha et al. TEG Among Cancer Patients normal TEGs in the >50,000/mm 3 groups, as well as the improved survival, suggest that with appropriate clinical indication and risk/benefit assessment, a cutoff of 50,000/mm 3 platelets can be considered for CA in cancer patients.

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Acute Coronary Syndrome, Thrombocytopenia, and Antiplatelet Therapy in Critically Ill Cancer Patients

Donisan¹,

Balanescu²,

Iliescu³

et al. 2019

Oncologic Critical Care

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Safety of Diagnostic and Therapeutic Cardiac Catheterization in Cancer Patients With Acute Coronary Syndrome and Chronic Thrombocytopenia

Cited by 39 publications

References 17 publications

Management strategies and clinical outcomes of acute myocardial infarction in leukaemia patients: Nationwide insights from United States hospitalisations

Management strategies and clinical outcomes of acute myocardial infarction in leukaemia patients: Nationwide insights from United States hospitalisations

Identifying Hemostatic Thresholds in Cancer Patients Undergoing Coronary Angiography Based on Platelet Count and Thromboelastography

Acute Coronary Syndrome, Thrombocytopenia, and Antiplatelet Therapy in Critically Ill Cancer Patients

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