Thrombocytopenia in Patients Treated with Heparin, Combination Antiplatelet Therapy, and Intra‐Aortic Balloon Pump Counterpulsation

Bream-Rouwenhorst, Heather R.; Hobbs, Ryan A.; Horwitz, Phillip A.

doi:10.1111/j.1540-8183.2008.00363.x

Cited by 21 publications

(21 citation statements)

References 21 publications

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“…1,10 As in the study by Bream-Rouwenhorst et al, we found that the degree of platelet count reduction was greater among patients with HIT than among those without HIT. 1 Because of the important clinical implications of this diagnosis, this finding suggests that IABP patients who are receiving heparin and who have a marked reduction in platelet count (>50%) should be considered for HIT testing.…”

Section: Discussionsupporting

confidence: 75%

“…Further, on multivariate modeling, heparin use was not an independent predictor of thrombocytopenia. In conjunction with previous data demonstrating that the reduction in platelet count among patients undergoing IABP is independent of the use of clopidogrel and glycoprotein IIb/IIIa inhibitors, 1 it becomes clear that this phenomenon is largely a result of the mechanical effects of IABP.…”

Section: Discussionmentioning

confidence: 57%

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

Roy

Howard

Panza

et al. 2010

Clinical Cardiology

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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.

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Section: Discussionsupporting

confidence: 75%

Section: Discussionmentioning

confidence: 57%

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

Roy

Howard

Panza

et al. 2010

Clinical Cardiology

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“…In a study of 109 patients, 59 47% of patients with IABPs developed thrombocytopenia compared to 12% of patients not on IABPs. In a contemporary retrospective cohort study of 107 patients who had an IABP, 60 the incidence of thrombocytopenia was 57.9%. In both studies, platelet counts fell steadily until the third or the fourth day of IABP use and then stabilized.…”

mentioning

confidence: 99%

“…More than 4 hours of pretreatment with heparin has been shown to be independently predictive of post‐PCI thrombocytopenia 3 . Similarly, the occurrence and severity of IABP‐related thrombocytopenia is dependent on the duration of IABP use 60 …”

mentioning

confidence: 99%

Thrombocytopenia following Percutaneous Coronary Intervention

Shenoy

Harjai

2011

Journal of Interventional Cardiology

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“…Based on the fundamental in vitro and in vivo experiments, antiplatelet drugs might prevent the occurrence of HIT [38], [39]; by contrast, several clinical trials have confirmed that antiplatelet drugs do not effectively suppress the occurrence of HIT [40], and antiplatelet drugs do not reduce the occurrence and degree of thrombocytopenia [41]. However, these studies were limited to case reports or research using a small sample size.…”

Section: Discussionmentioning

confidence: 99%

The Clinical Significance and Risk Factors of Anti-Platelet Factor 4/heparin Antibody on Maintenance Hemodialysis Patients: A Two-Year Prospective Follow-up

Zhao

Sun

et al. 2013

PLoS ONE

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BackgroundHeparin-induced thrombocytopenia is an immune response mediated by anti-PF4/heparin antibody, which is clinically characterized by thrombocytopenia and thromboembolic events. In this study, a prospective and multi-center clinical investigation determined the positive rate of anti-PF4/heparin antibody in maintenance hemodialysis patients in China, identified the related risk factors, and further explored the effect of the anti-PF4/heparin antibody on bleeding, thromboembolic events, and risk of death in the patients.MethodsThe serum anti-PF4/heparin antibody was measured in 661 patients from nine hemodialysis centers, detected by IgG-specific ELISA and followed by confirmation with excess heparin. Risk factors of these patients were analyzed. Based on a two-year follow-up, the association between the anti-PF4/heparin antibody and bleeding, thromboembolic events, and risk of death in the patients was investigated.Results The positivity rate of the anti-PF4/heparin antibody in maintenance hemodialysis patients was 5.6%. With diabetes as an independent risk factor, the positivity rate of the anti-PF4/heparin antibody decreased in the patients undergoing weekly dialyses ≥3 times. The positivity rate of the anti-PF4/heparin antibody was not related to the occurrence of clinical thromboembolic events and was not a risk factor for death within two years in maintenance hemodialysis patients. Negativity for the anti-PF4/heparin antibody combined with a reduction of the platelet count or combined with the administration of antiplatelet drugs yielded a significant increase in bleeding events. However, the composite determination of the anti-PF4/heparin antibody and thrombocytopenia, as well as the administration of antiplatelet drugs, was not predictive for the risk of thromboembolic events in the maintenance hemodialysis patients.ConclusionsA single detection of the anti-PF4/heparin antibody did not predict the occurrence of clinical bleeding, thromboembolic events, or risk of death in the maintenance hemodialysis patients.

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Thrombocytopenia in Patients Treated with Heparin, Combination Antiplatelet Therapy, and Intra‐Aortic Balloon Pump Counterpulsation

Cited by 21 publications

References 21 publications

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

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

Thrombocytopenia following Percutaneous Coronary Intervention

The Clinical Significance and Risk Factors of Anti-Platelet Factor 4/heparin Antibody on Maintenance Hemodialysis Patients: A Two-Year Prospective Follow-up

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