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Kidambi BR, Veeraraghavan S, Subbaraju P. Answer: Pause and paucity. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:259-260. [PMID: 38300521 DOI: 10.1093/ehjacc/zuad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Affiliation(s)
| | - Sriram Veeraraghavan
- Department of Cardiology, SRM Medical College Hospital and Research Center, Chennai, India
| | - Prasanna Subbaraju
- Department of Cardiology, SRM Medical College Hospital and Research Center, Chennai, India
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Wang ZM, Wang B, Li YF, Chen B, Shen Q, Li DF, Wang LS. Severe thrombocytopenia induced by tirofiban after percutaneous coronary intervention: a case report. J Med Case Rep 2023; 17:430. [PMID: 37838704 PMCID: PMC10576886 DOI: 10.1186/s13256-023-04169-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 09/09/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Tirofiban is a nonpeptide glycoprotein IIb/IIIa receptor antagonist used widely in patients subjected to percutaneous coronary intervention. While the usage of tirofiban sets an important clinical benefit, severe thrombocytopenia can occur with use of this agent. CASE PRESENTATION A 76-year-old Chinese man was admitted with 1-month history of sudden onset of chest tightness. He was diagnosed as having subacute inferior myocardial infarction, and percutaneous coronary intervention was performed. After the procedure, patient received tirofiban at 0.15 µg/kg/minute for 4 h. A blood sample was obtained for a complete blood count; severe thrombocytopenia was reported according to routine orders at our hospital. All antiplatelet drugs including tirofiban, aspirin, and clopidogrel were immediately discontinued. The patient received platelet transfusions and was treated with immunoglobulin G. Two days later, the patient's platelet count had increased to 75 × 109/L. There was a significant improvement after day 5, and the platelet count was 112 × 109/L. Seven days after the acute thrombocytopenia, he was discharged with normal platelet count. CONCLUSIONS Clinicians should be particularly aware of tirofiban-induced thrombocytopenia in routine practice.
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Affiliation(s)
- Ze-Mu Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Bin Wang
- Institute of Nephrology, Zhong Da Hospital, Southeast University School of Medicine, Nanjing, China
| | - Ya-Fei Li
- Department of Cardiology, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Gusu School, Nanjing Medical University, Suzhou, China
| | - Bei Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Qin Shen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dian-Fu Li
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lian-Sheng Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Shanmuganathan JWD, Kragholm K, Tayal B, Polcwiartek C, Poulsen LØ, El-Galaly TC, Fosbøl EL, D’Souza M, Gislason G, Køber L, Schou M, Nielsen D, Søgaard P, Torp-Pedersen CT, Mamas MA, Freeman P. Risk for Myocardial Infarction Following 5-Fluorouracil Treatment in Patients With Gastrointestinal Cancer. JACC CardioOncol 2021; 3:725-733. [PMID: 34988482 PMCID: PMC8702810 DOI: 10.1016/j.jaccao.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/05/2021] [Accepted: 11/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background Myocardial infarction is a cardiac adverse event associated with 5-fluorouracil (5-FU). There are limited data on the incidence, risk, and prognosis of 5-FU-associated myocardial infarction. Objectives The aim of this study was to examine the risk for myocardial infarction in patients with gastrointestinal (GI) cancer treated with 5-FU compared with age- and sex-matched population control subjects without cancer (1:2 ratio). Methods Patients with GI cancer treated with 5-FU between 2004 and 2016 were identified within the Danish National Patient Registry. Prevalent ischemic heart disease in both groups was excluded. Cumulative incidences were calculated, and multivariable regression and competing risk analyses were performed. Results A total of 30,870 patients were included in the final analysis, of whom 10,290 had GI cancer and were treated with 5-FU and 20,580 were population control subjects without cancer. Differences in comorbid conditions and select antianginal medications were nonsignificant (P > 0.05 for all). The 6-month cumulative incidence of myocardial infarction was significantly higher for 5-FU patients at 0.7% (95% CI: 0.5%-0.9%) versus 0.3% (95% CI: 0.3%-0.4%) in population control subjects, with a competing risk for death of 12.1% versus 0.6%. The 1-year cumulative incidence of myocardial infarction for 5-FU patients was 0.9% (95% CI: 0.7%-1.0%) versus 0.6% (95% CI: 0.5%-0.7%) among population control subjects, with a competing risk for death of 26.5% versus 1.4%. When accounting for competing risks, the corresponding subdistribution hazard ratios suggested an increased risk for myocardial infarction in 5-FU patients, compared with control subjects, at both 6 months (hazard ratio: 2.10; 95% CI: 1.50-2.95; P < 0.001) and 12 months (hazard ratio: 1.39; 95% CI: 1.05-1.84; P = 0.022). Conclusions Despite a statistically significantly higher 6- and 12-month risk for myocardial infarction among 5-FU patients compared with population control subjects, the absolute risk for myocardial infarction was low, and the clinical significance of these differences appears to be limited in the context of the significant competing risk for death in this population.
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Akashi A, Kamada M, Nakagawa N, Ishiguchi Y, Moritou Y, Hara M, Eguchi Y. Perioperative changes in platelet count in patients with atrial septal defect. Pediatr Int 2021; 63:516-522. [PMID: 32614463 DOI: 10.1111/ped.14369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 05/14/2020] [Accepted: 06/25/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Platelet count and function change following atrial septal defect (ASD) closure with the Amplatzer septal occluder (ASO). However, the clinical significance of these changes remains unclear. We examined changes in platelet count and mean platelet volume (MPV) before and after ASO placement, and the association between platelet count, MPV and various factors. We discussed the mechanism and clinical significance of changes in platelet count and MPV. METHODS We evaluated 109 patients with ASD who underwent ASO placement, and we performed various analyses of platelet count and MPV. RESULTS Younger patients typically had higher platelet counts and lower MPV on admission. They also had large ASDs relative to their body constitution; larger devices were therefore used. Rates of change in platelet count were higher in younger patients. There were no significant associations between platelet count or MPV before placement and mean pulmonary artery pressure, and Qp/Qs, and between the number of thrombocytopenia and presence or absence of headache or residual ASD. Platelet counts decreased on average by 21.3% for the first 3 days after ASO placement. One month after placement, platelet counts were slightly improved but remained lower than before placement. Conversely, MPV increased significantly after ASO placement and remained high a month after placement. The ASO size was the most influential factor in platelet count reduction after ASD closure by ASO. CONCLUSIONS One month after ASO placement, platelet counts decreased and MPVs continued to increase, suggesting that platelet consumption and new production were still occurring a month after placement.
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Affiliation(s)
- Akiko Akashi
- Department of Pediatric Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Masahiro Kamada
- Department of Pediatric Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Naomi Nakagawa
- Department of Pediatric Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yukiko Ishiguchi
- Department of Pediatric Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yuuji Moritou
- Department of Pediatric Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Mayuko Hara
- Department of Pediatric Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yoshimi Eguchi
- Department of Pediatric Cardiology, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
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Khan MR, Adhikari G, Khan H, Changezi HU. A case report of absolute thrombocytopenia with ticagrelor. Eur Heart J Case Rep 2020; 4:1-5. [PMID: 32974480 DOI: 10.1093/ehjcr/ytaa169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/02/2020] [Accepted: 05/20/2020] [Indexed: 11/12/2022]
Abstract
BACKGROUND We report a rare case of absolute thrombocytopenia with ticagrelor after 6 h of single loading dose of ticagrelor. CASE SUMMARY A 68-year-old male with ischaemic cardiomyopathy, hypertension, and dyslipidaemia presented with chest pain. He was found to be in new-onset atrial flutter and ruled in for a non-ST-segment elevation myocardial infarction. An echocardiogram showed decreased left ventricular ejection fraction, estimated at 15-20% and serum troponin peaked at 0.2 ng/dL, baseline platelet count was 203 × 103/µL. He underwent a drug-eluting stent placement to the right coronary artery with excellent angiographic results. He received 3000 units of unfractionated heparin and 180 mg of ticagrelor during the procedure. About 6 h after the procedure, he had coffee ground emesis. A complete blood count revealed a platelet count of 2 × 103 and 0 × 103/µL on repeat testing. Peripheral smear did not show any evidence of platelet clumping and schistocytes, serum haptoglobin and lactate dehydrogenase were normal. Ticagrelor and heparin were discontinued, while the aspirin was continued. Five units of platelet were transfused. The platelet count improved to 200 × 103/µL. Since his CHADS2VASC score was 3, he was discharged on apixaban and clopidogrel in addition to other medication. No thrombocytopenia was seen on outpatient follow-up. DISCUSSION The common side effects of ticagrelor include bleeding, dyspnoea, gynaecomastia, and rarely thrombotic thrombocytopenic purpura. Although extremely rare, absolute or profound thrombocytopenia can occur with ticagrelor, hours after administration and should be considered when other potential causes of thrombocytopenia have been ruled out.
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Affiliation(s)
- Mahin R Khan
- Division of Cardiology, Department of Internal Medicine, McLaren-Flint/Michigan State University, 401 S Ballenger Hwy, Flint, MI 48532, USA
| | - Govinda Adhikari
- Department of Internal Medicine, McLaren-Flint/Michigan State University, 401 S Ballenger Hwy, Flint, MI 48532, USA
| | - Hafiz Khan
- Division of Cardiology, Department of Internal Medicine, McLaren-Flint/Michigan State University, 401 S Ballenger Hwy, Flint, MI 48532, USA
| | - Hameem U Changezi
- Division of Cardiology, Department of Internal Medicine, McLaren-Flint/Michigan State University, 401 S Ballenger Hwy, Flint, MI 48532, USA
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Jiang P, Gao Z, Zhao W, Song Y, Tang X, Xu J, Wang H, Jiang L, Chen J, Qiao S, Yang Y, Gao R, Xu B, Yuan J. Prognostic Significance of In-hospital Acquired Thrombocytopenia in Stable Coronary Artery Disease Undergoing Percutaneous Coronary Intervention. Am J Med Sci 2019; 358:19-25. [PMID: 31228966 DOI: 10.1016/j.amjms.2019.04.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 02/14/2019] [Accepted: 04/09/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND This large cohort study aimed to investigate the effect of acquired thrombocytopenia on the prognosis of patients with stable coronary artery disease undergoing percutaneous coronary intervention (PCI). MATERIALS AND METHODS Patients with stable coronary artery disease undergoing elective PCI were prospectively enrolled during 2013. All patients were followed for a median of 30 months (the 25th and 75th percentiles for follow-up time were 27 and 32 months). After excluding patients with baseline thrombocytopenia (<150 × 109/L), in-hospital acquired thrombocytopenia was defined as lowest platelet count <150 × 109/L or a relative reduction of 50% from the preoperative baseline platelet count after PCI. RESULTS A total of 3,614 patients were enrolled; 329 (7.8%) patients developed thrombocytopenia after PCI. Analyses showed no difference in adverse events between groups during hospitalization, while long-term all-cause mortality, minor bleeding and major bleeding were significantly higher in patients with thrombocytopenia than in the control group. After multivariable adjustment, thrombocytopenia remained an independent risk factor for long-term all-cause mortality (HR 2.782, 95% CI 1.182-6.552, P = 0.019), minor bleeding (HR 2.198, 95% CI 1.217-3.972, P = 0.009) and major bleeding (HR 5.409, 95% CI 1.541-8.999, P = 0.008). Predictors of acquired thrombocytopenia were age, body mass index, baseline platelet count and left ventricular ejection fraction. CONCLUSIONS Acquired thrombocytopenia may predict long-term all-cause mortality and bleeding events in patients with stable coronary artery disease who receive elective PCI.
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Affiliation(s)
- Ping Jiang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Centre for Coronary Heart Disease, Fuwai Hospital, Beijing, China; National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhan Gao
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Centre for Coronary Heart Disease, Fuwai Hospital, Beijing, China; National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wei Zhao
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Centre for Coronary Heart Disease, Fuwai Hospital, Beijing, China; National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Song
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Centre for Coronary Heart Disease, Fuwai Hospital, Beijing, China; National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiaofang Tang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Centre for Coronary Heart Disease, Fuwai Hospital, Beijing, China; National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingjing Xu
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Centre for Coronary Heart Disease, Fuwai Hospital, Beijing, China; National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huanhuan Wang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Centre for Coronary Heart Disease, Fuwai Hospital, Beijing, China; National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Jiang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Centre for Coronary Heart Disease, Fuwai Hospital, Beijing, China; National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jue Chen
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Centre for Coronary Heart Disease, Fuwai Hospital, Beijing, China; National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shubin Qiao
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Centre for Coronary Heart Disease, Fuwai Hospital, Beijing, China; National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuejin Yang
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Centre for Coronary Heart Disease, Fuwai Hospital, Beijing, China; National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Runlin Gao
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Centre for Coronary Heart Disease, Fuwai Hospital, Beijing, China; National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Xu
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Centre for Coronary Heart Disease, Fuwai Hospital, Beijing, China; National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jinqing Yuan
- State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Centre for Coronary Heart Disease, Fuwai Hospital, Beijing, China; National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
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Affiliation(s)
- Mamas A Mamas
- From the Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, United Kingdom (M.A.M.); Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom (M.A.M.); and Department of Cardiology, University Hospital Southampton, University of Southampton, United Kingdom (N.C.).
| | - Nick Curzen
- From the Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute of Primary Care and Health Sciences, Keele University, United Kingdom (M.A.M.); Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, United Kingdom (M.A.M.); and Department of Cardiology, University Hospital Southampton, University of Southampton, United Kingdom (N.C.)
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Thrombocytopenia and declines in platelet counts: predictors of mortality and outcome after mechanical thrombectomy. J Neurol 2019; 266:1588-1595. [PMID: 30915545 DOI: 10.1007/s00415-019-09295-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND PURPOSE Acute ischemic stroke (AIS) has well-known risk factors. The role of platelets in patients treated using mechanical thrombectomy (MT) has not been studied. The aim of this study was to study if there is an association of initial thrombocytopenia (TP) and a decline of platelets counts (DPC) with the clinical outcomes, mortality and intracranial hemorrhage (ICH) rates in AIS patients treated with MT. MATERIALS AND METHODS In a case-control study consecutive MT-stroke patients were analyzed. A multivariate logistic regression model was used to test for good clinical outcome (mRS 90 days <= 2) and mortality adjusting for age, initial NIHSS, pretreatment with tPA, statins and platelet inhibitors, occlusion site, time from symptom onset to recanalization, initial TP (< 150 × 109/L) and DPC (> 26%). Additionally, rates of ICH were compared. RESULTS Of 294 patients included, 9.6% had an initial TP and 23.8% a DPC > 26%. The mortality rate in patients with normal platelet counts was 26.1% vs. 48.3% (p = 0.002) in patients with initial TP with an aOR of 3.47 (CI 1.28-9.4, p = 0.005). No difference regarding the rate of good clinical outcome (p = 0.204) and ICH (p = 0.18) was observed. A DPC of more than 26% during the first 5 days of hospitalization predicted the rate of mortality (aOR 2.4 CI 1.14-5.04, p = 0.021) and the chances of a good clinical outcome (aOR 0.291 CI 0.128-0.666, p = 0.003) without significant differences of ICH rates (p = 0.735). CONCLUSION In AIS patients treated with MT an initial TP was independently associated with higher mortality rates and a marked DPC with higher mortality rates as well as poorer clinical outcomes.
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Liu S, Song C, Zhao Y, Guan C, Zhu C, Feng L, Xu B, Dou K. Impact of baseline thrombocytopenia on the long-term outcome of patients undergoing elective percutaneous coronary intervention: An analysis of 9,897 consecutive patients. Catheter Cardiovasc Interv 2018; 93:764-771. [PMID: 30585392 DOI: 10.1002/ccd.28030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 12/02/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVES This study aimed to investigate the association between baseline thrombocytopenia and long-term clinical outcomes among patients undergoing elective percutaneous coronary intervention (PCI). BACKGROUND Thrombocytopenia (TP) commonly occurs among patients undergoing PCI. However, whether TP has any influence on the outcome of PCI patients remains controversial. METHODS We examined 9,897 consecutive patients who underwent elective PCI in Fuwai Hospital from January 2013 to December 2013. Baseline thrombocytopenia was defined as platelet count <150 × 109 /L. We compared data on demographic, clinical, laboratory, and 30-month outcomes between nonthrombocytopenic and thrombocytopenic patients. The primary outcome was death and major adverse cardiovascular events (MACE) during the 30-month follow-up. Logistic regression analyses were performed to identify risk factors of baseline thrombocytopenia. RESULTS Baseline thrombocytopenia developed in 1263 (12.76%) patients; of these, 1,172 (11.84%) patients had mild thrombocytopenia and 91 (0.92%) had the moderate or severe type. No differences in all-cause mortality, stent thrombosis, target vessel revascularization, MACE, or bleeding complications were detected between patients with and without thrombocytopenia. Further, advanced age, male sex, previous PCI history, previous myocardial infarction history, and diabetes mellitus history were found to be risk factors of baseline thrombocytopenia. CONCLUSIONS Although baseline thrombocytopenia was common among patients who underwent elective PCI, it did not appear to have a clinically significant effect on long-term adverse outcomes, particular bleeding risk. Our results indicated that it seems to be feasible for patients with mild to moderate thrombocytopenia to receive elective PCI as well as guideline-recommended duration of anti-platelet therapy.
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Affiliation(s)
- Shuai Liu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Chenxi Song
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Yanyan Zhao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Changdong Guan
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Chenggang Zhu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Lei Feng
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Bo Xu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Kefei Dou
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
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Potts JE, Iliescu CA, Lopez Mattei JC, Martinez SC, Holmvang L, Ludman P, De Belder MA, Kwok CS, Rashid M, Fischman DL, Mamas MA. Percutaneous coronary intervention in cancer patients: a report of the prevalence and outcomes in the United States. Eur Heart J 2018; 40:1790-1800. [DOI: 10.1093/eurheartj/ehy769] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 07/25/2018] [Accepted: 11/16/2018] [Indexed: 12/17/2022] Open
Affiliation(s)
- Jessica E Potts
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele Road, Stoke-on-Trent, UK
| | - Cezar A Iliescu
- Department of Cardiology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Juan C Lopez Mattei
- Department of Cardiology, MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Sara C Martinez
- Division of Cardiology, Providence St. Peter Hospital, Olympia, WA, USA
| | - Lene Holmvang
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Ludman
- Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Mark A De Belder
- Department of Cardiology, James Cook University Hospital, Middlesborough, UK
| | - Chun Shing Kwok
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele Road, Stoke-on-Trent, UK
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele Road, Stoke-on-Trent, UK
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
| | - David L Fischman
- Department of Medicine (Cardiology), Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele Road, Stoke-on-Trent, UK
- Academic Department of Cardiology, Royal Stoke Hospital, Stoke-on-Trent, UK
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Liu S, Song C, Zhao Y, Zhu C, Feng L, Dou K, Xu B. The impact of acquired thrombocytopenia on long-term outcomes of patients undergoing elective percutaneous coronary intervention: An analysis of 8,271 consecutive patients. Catheter Cardiovasc Interv 2018; 91:558-565. [PMID: 29368387 DOI: 10.1002/ccd.27498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 12/27/2017] [Indexed: 11/09/2022]
Affiliation(s)
- Shuai Liu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College; Beijing China
| | - Chenxi Song
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College; Beijing China
| | - Yanyan Zhao
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College; Beijing China
| | - Chenggang Zhu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College; Beijing China
| | - Lei Feng
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College; Beijing China
| | - Kefei Dou
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College; Beijing China
| | - Bo Xu
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College; Beijing China
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Ferreira RM, Mansur Filho J, Villela PB, Almeida JCGD, Sampaio PPN, Albuquerque FND, Pulcheri W, Benchimol CB. Contrast-induced thrombocytopenia following percutaneous coronary intervention. J Saudi Heart Assoc 2017; 29:227-229. [PMID: 28652679 PMCID: PMC5475342 DOI: 10.1016/j.jsha.2017.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 01/22/2017] [Indexed: 11/30/2022] Open
Abstract
Contrast-induced thrombocytopenia is a rare complication distinguished by acute and severe platelet consumption, with spontaneous recovery within days. We describe a case of acute thrombocytopenia 6 hours after coronary angioplasty in a patient with a negative antiplatelet factor 4 test. The count reached 1 × 103/µL, but improved spontaneously to 210 × 103/µL after 8 days. In conclusion, physicians should be aware of this complication, particularly when dual antiplatelet therapy is being considered.
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Affiliation(s)
- Roberto Muniz Ferreira
- Cardiology Department, Samaritano Hospital, Rio de Janeiro, RJ, Brazil
- Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
- Corresponding author at: Samaritano Hospital, Cardiology Department, Rua Bambina 98, Botafogo, Rio de Janeiro, RJ 22251-050, Brazil.Samaritano HospitalCardiology DepartmentRua Bambina 98BotafogoRio de JaneiroRJ22251-050Brazil
| | - João Mansur Filho
- Cardiology Department, Samaritano Hospital, Rio de Janeiro, RJ, Brazil
| | - Paolo Blanco Villela
- Cardiology Department, Samaritano Hospital, Rio de Janeiro, RJ, Brazil
- Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | - Juliano Carvalho Gomes de Almeida
- Cardiology Department, Samaritano Hospital, Rio de Janeiro, RJ, Brazil
- Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| | | | | | - Wolmar Pulcheri
- Cardiology Department, Samaritano Hospital, Rio de Janeiro, RJ, Brazil
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13
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Oikonomou EK, Repanas TI, Papanastasiou C, Kokkinidis DG, Miligkos M, Feher A, Gupta D, Kampaktsis PN. The effect of in-hospital acquired thrombocytopenia on the outcome of patients with acute coronary syndromes: A systematic review and meta-analysis. Thromb Res 2016; 147:64-71. [PMID: 27689317 DOI: 10.1016/j.thromres.2016.09.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 09/15/2016] [Accepted: 09/22/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND In-hospital acquired thrombocytopenia (TP) is relatively common among patients hospitalized with acute coronary syndromes (ACS). However, its effect on short-term and long-term outcomes has yet to be reviewed systematically. METHODS We conducted a systematic review and meta-analysis of clinical studies assessing the relationship between new-onset in-hospital TP and adverse outcomes among ACS patients. MEDLINE, Scopus and the Cochrane Library were searched for eligible studies published before March 20, 2016. RESULTS Ten studies reporting on a total of 142,161 ACS patients were identified. 8133 patients showed evidence of new-onset TP during the course of their hospitalization. Compared with patients with normal platelet counts, patients with new-onset TP had a prolonged in-hospital stay, significantly higher risk of both short-term mortality (<30days) (Odds ratio (OR) [95% confidence interval (CI)]: 5.58 [3.63-8.57]) and late death (6months to 1year) (OR [95% CI]: 3.45 [2.35-5.07]), as well as a significantly higher risk of major bleeding events in the first 30days (OR [95% CI]: 6.93 [5.13-9.38]). In addition, risk for other secondary cardiovascular endpoints, including recurrent myocardial infarction, stroke, in-hospital heart failure, stent thrombosis and unplanned revascularization was also significantly higher in the TP versus the no TP group. CONCLUSIONS Development of TP during the in-hospital management of ACS patients is a significant predictor of both short- and long-term adverse events, including mortality. In the light of this evidence, clinicians should be cautious and closely monitor abnormal platelet counts that present early following an ACS.
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Affiliation(s)
- Evangelos K Oikonomou
- Society of Junior Doctors, Athens, Greece; National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece.
| | | | - Christos Papanastasiou
- Society of Junior Doctors, Athens, Greece; Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Damianos G Kokkinidis
- Society of Junior Doctors, Athens, Greece; Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece
| | - Michael Miligkos
- Society of Junior Doctors, Athens, Greece; Laboratory of Biomathematics, University of Thessaly School of Medicine, Larissa, Greece
| | - Attila Feher
- New York Presbyterian Hospital/Weill Cornell Medical College, Department of Medicine, NY, USA
| | - Dipti Gupta
- Memorial Sloan Kettering Cancer Center, Cardiology Service, New York, USA
| | - Polydoros N Kampaktsis
- Society of Junior Doctors, Athens, Greece; New York Presbyterian Hospital/Weill Cornell Medical College, Department of Medicine, NY, USA
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14
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Wessler JD, Giugliano RP. Risk of thrombocytopenia with glycoprotein IIb/IIIa inhibitors across drugs and patient populations: a meta-analysis of 29 large placebo-controlled randomized trials. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2015; 1:97-106. [DOI: 10.1093/ehjcvp/pvu008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 09/27/2014] [Indexed: 11/14/2022]
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Hatz MHM, Leidl R, Yates NA, Stollenwerk B. A systematic review of the quality of economic models comparing thrombosis inhibitors in patients with acute coronary syndrome undergoing percutaneous coronary intervention. PHARMACOECONOMICS 2014; 32:377-393. [PMID: 24504849 DOI: 10.1007/s40273-013-0128-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Thrombosis inhibitors can be used to treat acute coronary syndromes (ACS). However, there are various alternative treatment strategies, of which some have been compared using health economic decision models. OBJECTIVE To assess the quality of health economic decision models comparing thrombosis inhibitors in patients with ACS undergoing percutaneous coronary intervention, and to identify areas for quality improvement. DATA SOURCES The literature databases MEDLINE, EMBASE, EconLit, National Health Service Economic Evaluation Database (NHS EED), Database of Abstracts of Reviews of Effects (DARE) and Health Technology Assessment (HTA). STUDY APPRAISAL AND SYNTHESIS METHODS A review of the quality of health economic decision models was conducted by two independent reviewers, using the Philips checklist. RESULTS Twenty-one relevant studies were identified. Differences were apparent regarding the model type (six decision trees, four Markov models, eight combinations, three undefined models), the model structure (types of events, Markov states) and the incorporation of data (efficacy, cost and utility data). Critical issues were the absence of particular events (e.g. thrombocytopenia, stroke) and questionable usage of utility values within some studies. LIMITATIONS As we restricted our search to health economic decision models comparing thrombosis inhibitors, interesting aspects related to the quality of studies of adjacent medical areas that compared stents or procedures could have been missed. CONCLUSIONS This review identified areas where recommendations are indicated regarding the quality of future ACS decision models. For example, all critical events and relevant treatment options should be included. Models also need to allow for changing event probabilities to correctly reflect ACS and to incorporate appropriate, age-specific utility values and decrements when conducting cost-utility analyses.
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Affiliation(s)
- Maximilian H M Hatz
- Hamburg Center for Health Economics, University of Hamburg, 20354, Hamburg, Germany,
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16
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Morici N, Cantoni S, Savonitto S. Antiplatelet therapy for patients with stable ischemic heart disease and baseline thrombocytopenia: Ask the hematologist. Platelets 2013; 25:455-60. [DOI: 10.3109/09537104.2013.828029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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