Evaluation of thrombocytopenia in the acute coronary syndrome

Thrombocytopenia is relatively common in patients with acute coronary syndromes and is associated with an increased risk of adverse outcomes, regardless of the etiology of the low platelet count. Treatment strategies, both medical and mechanical, may cause thrombocytopenia. This review will introduce a differential diagnosis, diagnostic strategies, and treatment options for patients with an acute coronary syndrome.

Recent data has strengthened the relationship between thrombocytopenia and adverse outcomes, particularly death and bleeding, in this population of cardiac patients. In addition, bleeding is recognized as a strong independent predictor of an adverse event. Thrombocytopenia may be a marker for acuity of illness and often may be only an association between a low platelet count and therapeutic interventions in this population. Nevertheless, thrombocytopenia due to glycoprotein 2b3a receptor inhibitors, heparins, thienopyridines, and intra-aortic balloon pumps must be recognized and managed appropriately.

Surveillance for and early recognition of thrombocytopenia, an appropriate differential diagnosis, and early institution of treatment are critically important in the management of patients with acute coronary syndromes.