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Published on: March 15, 2022
Decline in platelet count in patients treated by percutaneous coronary intervention: definition, incidence,
Axel De Labriolle1, Laurent Bonello, Gilles Lemesle
1Department of Internal Medicine, Division of Cardiology, Washington Hospital Center, 110 Irving Street, NW, Suite 4B-1, Washington, DC 20010, USA.
Insights
A decline in platelet count (DPC) after percutaneous coronary intervention (PCI) predicts adverse outcomes. Moderate to severe DPC increases bleeding and ischemic risks, suggesting procedural modifications can reduce thrombocytopenia incidence.
Area of Science:
- Cardiology
- Hematology
Background:
- Percutaneous coronary intervention (PCI) is a common procedure.
- Understanding complications like decline in platelet count (DPC) is crucial for patient outcomes.
Purpose of the Study:
- To investigate the incidence, predictors, and prognostic impact of DPC in patients undergoing PCI.
Main Methods:
- Analysis of 10,146 patients treated with PCI between 2003 and 2006.
- Patients categorized into four DPC groups: <10%, 10-24%, 25-49%, and >=50%.
- Primary endpoints included major bleeding and 30-day all-cause mortality/myocardial infarction.
Main Results:
- 36% had <10% DPC, 47.7% had 10-24% DPC, 14% had 25-49% DPC, and 2.3% had >=50% DPC.
- Moderate and severe DPC were independent predictors of ischemic outcomes.
- Intraprocedural heparin use and low molecular weight contrast material were associated with severe DPC.
Conclusions:
- Moderate and severe DPC independently predict adverse bleeding and ischemic outcomes in PCI patients.
- Using anticoagulants other than heparin and avoiding low molecular weight contrast agents may reduce severe DPC.
Aims:
We investigated the incidence, predictors, and prognostic impact of a decline in platelet count (DPC) in patients treated by percutaneous coronary intervention (PCI).
Methods And Results:
A total of 10 146 consecutive patients treated by PCI from 2003 to 2006 were included. According to the magnitude of the DPC, the population was divided into four groups: no DPC (<10%), minor DPC (10-24%), moderate DPC (25-49%), and severe DPC (>or=50%). The primary haemorrhagic endpoint was a composite of post-procedure surgical repair major bleeding. The primary ischaemic endpoint was 30-day all-cause mortality-non-fatal myocardial infarction. Among the total population, 36% had a DPC <10%, 47.7% had a DPC of 10-24%, 14% had a DPC of 25-49%, and 2.3% had a DPC >or=50%. On multivariate analysis, moderate and severe DPC were independent predictive factors of the ischaemic outcome. Two procedural practices were identified that, if modified, might reduce the incidence of acquired thrombocytopaenia. Both the intraprocedural use of heparin (as opposed to bivalirudin) and of low molecular weight contrast material were independently associated with severe acquired thrombocytopaenia.
Conclusion:
Moderate and severe DPC are independent predictors of adverse bleeding and ischaemic outcomes in PCI. Adoption of intraprocedural anticoagulant other than heparin and avoidance of a low molecular weight contrast agent could potentially decrease the occurrence of severe acquired thrombocytopaenia.
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