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Concurrent coronary artery disease and immune thrombocytopenia: a systematic review
Alaa Rahhal1, Drew Provan2, Khaled Shunnar3
1Pharmacy Department, Hamad Medical Corporation, Doha, Qatar.
Insights
Managing coronary artery disease (CAD) with immune thrombocytopenia (ITP) is challenging. Revascularization via PCI or CABG is feasible with ITP treatments like corticosteroids and IVIG, but carries bleeding and mortality risks.
Area of Science:
- Cardiology
- Hematology
- Clinical Medicine
Background:
- Coronary artery disease (CAD) management is complex in patients with immune thrombocytopenia (ITP) due to balancing bleeding and thrombosis risks.
- Limited evidence exists for guiding treatment decisions in this dual-diagnosis population.
Approach:
- A systematic review adhering to PRISMA guidelines was performed.
- Literature search of PubMed and Embase databases for studies on CAD and ITP management up to October 2022.
- Data extraction included patient characteristics, CAD treatments, ITP therapies, and outcomes by two independent reviewers.
Key Points:
- 32 CAD cases with ITP were analyzed; 18 underwent percutaneous coronary intervention (PCI) and 12 underwent coronary artery bypass graft surgery (CABG).
- Patients had a mean age of 61 years and a mean platelet count of 52 × 109/L.
- Common ITP treatments included corticosteroids and intravenous immunoglobulins (IVIG), alone or combined.
Conclusions:
- Revascularization (PCI or CABG) is feasible in CAD patients with ITP when managed concurrently with ITP-specific therapies.
- This approach carries a significant risk of bleeding and mortality, necessitating careful clinical consideration.
Introduction:
Coronary artery disease (CAD) management in the setting of immune thrombocytopenia (ITP) remains very challenging to clinicians as a reasonable balance between bleeding and thrombosis risks needs to be achieved, and the evidence guiding such management is scarce.
Methods:
We conducted a systematic review following the PRISMA guidelines to summarize the available literature on the management and outcomes of CAD coexisting with ITP. We searched PubMed and Embase for studies published in English exploring CAD and ITP management until 05 October 2022. Two independent reviewers screened and assessed the articles for inclusion. Patients' characteristics, CAD treatment modalities, ITP treatment, and complications were reported.
Results:
We identified 32 CAD cases, among which 18 cases were revascularized with percutaneous coronary intervention (PCI), 12 cases underwent coronary artery bypass graft surgery (CABG), and two cases were managed conservatively. More than 50% were men, with a mean age of 61 ± 13 years and a mean baseline platelet count of 52 ± 59 × 109/L. Irrespective of the revascularization modality, most patients were treated with either corticosteroids alone, intravenous immunoglobulins (IVIG) alone, or in combination. Among those who underwent PCI, two patients had bleeding events, and one patient died. Similarly, among those with CABG, one patient developed bleeding, and one patient died.
Conclusion:
We found that revascularization with either PCI or CABG with the concurrent use of corticosteroids and/or IVIG for ITP was feasible, with an existing non-negligible risk of bleeding and mortality.
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