This Article Full Text Full Text (PDF) All Versions of this Article: 119/18/2454    most recent CIRCULATIONAHA.108.827162v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wang, T. Y. Articles by Peterson, E. D. Search for Related Content PubMed PubMed Citation Articles by Wang, T. Y. Articles by Peterson, E. D. Related Collections Acute coronary syndromes Related Articles

(Circulation. 2009;119:2454-2462.)
© 2009 American Heart Association, Inc.

Coronary Heart Disease

Incidence and Prognostic Significance of Thrombocytopenia Developed During Acute Coronary Syndrome in Contemporary Clinical Practice

Tracy Y. Wang, MD, MHS; Fang-Shu Ou, MS; Matthew T. Roe, MD, MHS; Robert A. Harrington, MD; E. Magnus Ohman, MD; W. Brian Gibler, MD; Eric D. Peterson, MD, MPH

From the Duke Clinical Research Institute, Durham, NC (T.Y.W., F.-S.O., M.T.R., R.A.H., E.M.O., E.D.P.), and the University of Cincinnati College of Medicine, Cincinnati, Ohio (W.B.G.).

Correspondence to Tracy Y. Wang, MD, MS, Duke Clinical Research Institute, 2400 Pratt St, Room 0311, Terrace Level, Durham, NC 27705. E-mail wang0085{at}mc.duke.edu

Received October 15, 2008; accepted February 10, 2009.

Background— Prior studies examining thrombocytopenia among patients with acute coronary syndromes (ACS) evaluated highly selected patients in a clinical trial setting using varying definitions of thrombocytopenia. The incidence, severity, and prognostic significance of acquired thrombocytopenia during ACS in community practice have not been well defined.

Methods and Results— We examined 36 182 patients with non–ST-segment elevation ACS enrolled at 379 US hospitals participating in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) quality improvement initiative between June 2004 and December 2006. Patients with baseline platelet counts <150x10⁹/L were excluded. Overall, 4697 patients (13%) developed new thrombocytopenia, defined as nadir platelet count <150x10⁹/L (referenced lower limit of normal), during their ACS hospitalization. Risks of in-hospital mortality and bleeding correlated directly with severity of thrombocytopenia; even mild thrombocytopenia (nadir 100 to 149x10⁹/L) was associated with increased risks of mortality (adjusted odds ratio [OR], 2.01; 95% CI, 1.69 to 2.38) and bleeding (adjusted OR, 3.76; 95% CI, 3.43 to 4.12). Each 10% drop in platelet count was associated with increased mortality and bleeding risks (adjusted ORs, 1.39 [95% CI, 1.33 to 1.46] and 1.89 [95% CI, 1.83 to 1.95], respectively). A 50% drop in platelet count was associated with higher risk of adverse outcomes regardless of the nadir count. A novel combined definition of acquired thrombocytopenia—nadir <150x10⁹/L or platelet count drop 50%—identifies a population of ACS patients at higher risk of mortality and major bleeding (adjusted ORs, 2.58 [95% CI, 2.23 to 2.98] and 4.32 [95% CI, 3.97 to 4.70], respectively).

Conclusions— Thrombocytopenia, a common complication of ACS, is associated with increased mortality and bleeding risks. Even mild thrombocytopenia or a platelet count drop 50% in the setting of normal nadir values is clinically significant. Application of a combined definition for thrombocytopenia using both absolute and relative thresholds permits increased sensitivity for patients at high risk of adverse outcomes.

---

 

CLINICAL PERSPECTIVE

Related Articles:

Clinical Summaries
Circulation 2009 119: 2417-2419. [Extract] [Full Text]

Adverse Prognostic Significance of Thrombocytopenia in Acute Coronary Syndrome: Can Anything Be Done About It?

Theodore E. Warkentin and Mark A. Crowther
Circulation 2009 119: 2420-2422. [Extract] [Full Text]

This article has been cited by other articles:

				R. P. Giugliano and E. Braunwald The Year in Non-ST-Segment Elevation Acute Coronary Syndrome. J. Am. Coll. Cardiol., October 13, 2009; 54(16): 1544 - 1555. [Full Text] [PDF]

				T. E. Warkentin and M. A. Crowther Adverse Prognostic Significance of Thrombocytopenia in Acute Coronary Syndrome: Can Anything Be Done About It? Circulation, May 12, 2009; 119(18): 2420 - 2422. [Full Text] [PDF]