Abstract 6049: Patients with Thrombocytopenia following Heparin Therapy Have Early but not Late Risk of Death: Results from the CATCH Registry
Background: Thrombocytopenia can occur after prolonged heparin therapy and is strongly related to worse short-term clinical outcome. Little is known about its impact on long-term outcome, but conventional wisdom has been that risk related to heparin-induced thrombocy-topenia persists for months, warranting oral anticoagulation.
Methods: CATCH explored the incidence, management, and clinical consequences of thrombocytopenia occurring during heparin-based anticoagulation in diverse clinical settings. We evaluated the relationship of in-hospital thrombocytopenia and 6-mo. mortality using Cox proportional hazard analysis.
Results: The mortality rate at 6 mos. was 12.1%, of which 9.6% occurred after hospital discharge. In the post-discharge period, when compared with pts who did not die by 6 mos., those who died were older, had Killip class III/IV, lower diastolic BP, lower heart rate, lower BMI, more history of CHF, renal dysfunction, and PVD. While thrombocytopenia was a strong predictor of early death, no difference was observed in post-discharge mortality between pts who did and did not develop thrombocytopenia (HR 0.83, 95% CI 0.63–1.11, p=0.211; Figure⇓). Strongest predictors of death post discharge were history of CHF (HR 2.01; 95% CI: 1.5–2.7) and history of renal dysfunction (HR 1.74; 95% CI: 1.27–2.38).
Conclusion: Six-month mortality of pts with thrombocytopenia following heparin exposure is high, but the excess risk is confined to the in-hospital phase. These results raise questions as to the optimal duration of anticoagulant therapy to treat the high risk of thrombosis following heparin-related thrombo-cytopenia, which may be confined to the acute phase.