Journal article
Thrombocytopenia in Patients Treated with Heparin, Combination Antiplatelet Therapy, and Intra-Aortic Balloon Pump Counterpulsation
Journal of interventional cardiology, Vol.21(4), pp.350-356
08/2008
DOI: 10.1111/j.1540-8183.2008.00363.x
PMID: 18537872
Abstract
Objectives: Determine the incidence and timing of intra-aortic balloon pump (IABP)-associated thrombocytopenia, if concomitant antiplatelet agents increase the incidence of thrombocytopenia, and the incidence of heparin-induced thrombocytopenia (HIT) in a contemporary IABP population.
Background: Previous studies predate the current practice of treating acute coronary syndrome patients with heparin and aspirin plus thienopyridines and glycoprotein IIb/IIIa receptor antagonists such that data are unavailable to determine if their co-administration worsens IABP-associated thrombocytopenia.
Methods: A retrospective cohort study of adult IABP patients (n = 107) from 2002 to 2006 was performed to determine the indication for and duration of counterpulsation, platelet counts during and for 7 days postcounterpulsation, medications potentially contributing to thrombocytopenia, and HIT antibody results if obtained.
Results: Thrombocytopenia, defined as platelets <150,000/mL or >50% decrease from baseline, occurred in 57.9% of patients. Overall, platelets declined to 60.2 +/- 22.8% of baseline with the mean (+/- standard deviation) nadir on day 2.8 +/- 2.0. Comparing patients who received heparin, aspirin, thienopyridines, and glycoprotein IIb/IIIa antagonists (n = 44) versus heparinized patients +/- aspirin (n = 45), platelet nadirs were 62.7 +/- 20.9% versus 58.3 +/- 23.9% of baseline levels, respectively (P = 0.42). The incidence of HIT was 2.8% in the entire cohort.
Conclusions: IABP-associated thrombocytopenia occurred in 57.9% of this cohort. HIT was diagnosed in 2.8% and should be considered as a diagnosis if platelet counts do not stabilize or continue to fall after 3-4 days of counterpulsation. Increased use of antiplatelet therapy does not impact the degree of thrombocytopenia although the current practice of prompt IABP removal may offset this effect.
Details
- Title: Subtitle
- Thrombocytopenia in Patients Treated with Heparin, Combination Antiplatelet Therapy, and Intra-Aortic Balloon Pump Counterpulsation
- Creators
- HEATHER R BREAM-ROUWENHORST - Clinical Pharmacy Specialist - Surgery/Transplant, Veterans Affairs Medical Center and Clinical Assistant Professor, University of Iowa College of Pharmacy, Iowa City, IowaRYAN A HOBBS - Clinical Pharmacy Specialist - Cardiology, Department of Pharmaceutical Care, University of Iowa Hospitals and Clinics, Iowa City, IowaPHILLIP A HORWITZ - Cardiovascular Medicine Faculty, Department of Internal Medicine, University of Iowa Hospitals and Clinics and Clinical Assistant Professor, University of Iowa Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa
- Resource Type
- Journal article
- Publication Details
- Journal of interventional cardiology, Vol.21(4), pp.350-356
- Publisher
- Blackwell Publishing Inc
- DOI
- 10.1111/j.1540-8183.2008.00363.x
- PMID
- 18537872
- ISSN
- 0896-4327
- eISSN
- 1540-8183
- Number of pages
- 7
- Language
- English
- Date published
- 08/2008
- Academic Unit
- Cardiovascular Medicine; Pharmacy Practice and Science; Internal Medicine
- Record Identifier
- 9984094873202771
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