Incidence and clinical consequences of acquired thrombocytopenia after antithrombotic therapies in patients with acute coronary syndromes: results from the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial.

Abstract

BACKGROUND:

The aim of the study was to investigate the incidence and clinical consequences of acquired thrombocytopenia in patients with acute coronary syndromes (ACS) in the ACUITY trial.

METHODS:

We examined 10,836 patients with ACS randomized to receive heparin plus glycoprotein (GP) IIb/IIIa inhibitor, bivalirudin plus GP IIb/IIIa inhibitor, or bivalirudin monotherapy.

RESULTS:

Acquired thrombocytopenia developed in 740 (6.8%) patients; mild (100,000-150,000 platelets/mm³), moderate (50,000-100,000 platelets/mm³), and severe (< 50,000 platelets/mm³) developed in 656 (6%), 51 (0.5%), and 33 (0.3%) patients, respectively. Patients with acquired thrombocytopenia, compared with those without, were more likely to develop major bleeding (14% vs 4.3%, P < .0001) at 30 days and had higher rates of mortality (6.5% vs 3.4%, P < .0001) at 1 year. By multivariate analysis, acquired thrombocytopenia was an independent predictor of major bleeding at 30 days (hazard ratio [HR] 1.68, 95% CI 1.04-2.72, P = .03). Moderate and severe acquired thrombocytopenia were predictors of mortality at 1 year (HR 2.89, 95% CI 0.92-9.06, P = .06, and HR 3.41, 95% CI 1.09-10.68, P = .03, respectively). Compared to heparin plus GP IIb/IIIa inhibitor, bivalirudin monotherapy was associated with less declines in platelet count by >25% (7.6% vs 5.6%, P = .0009) and >50% (1.4% vs 0.7%, P = .004) from baseline.

CONCLUSIONS:

Acquired thrombocytopenia occurs in approximately 1 in 14 patients with ACS treated with antithrombin and antiplatelet medications and is strongly associated with hemorrhagic and ischemic complications. Compared to an anticoagulant regimen including a GP IIb/IIIa inhibitor, administration of bivalirudin monotherapy appears to be associated with less frequent declines in platelet count.

• Authors: Adriano Caixeta, George D Dangas, Roxana Mehran, Frederick Feit, Eugenia Nikolsky, Alexandra J Lansky, Jiro Aoki, Jeffrey W Moses, Steven R Steinhubl, Harvey D White, E Magnus Ohman, Steven V Manoukian, Martin Fahy, Gregg W Stone
• Journal: American heart journal (Am Heart J) Vol. 161 Issue 2 Pg. 298-306.e1 (Feb 2011) ISSN: 1097-6744 [Electronic] United States
• PMID: 21315212 (Publication Type: Comparative Study, Journal Article, Multicenter Study, Randomized Controlled Trial)
• Copyright: Copyright © 2011 Mosby, Inc. All rights reserved.

Chemical References

• Fibrinolytic Agents
• Platelet Aggregation Inhibitors

Topics

• Acute Coronary Syndrome (drug therapy, therapy)
• Aged
• Cardiac Catheterization
• Emergency Treatment
• Female
• Fibrinolytic Agents (adverse effects, therapeutic use)
• Humans
• Incidence
• Male
• Middle Aged
• Platelet Aggregation Inhibitors (adverse effects, therapeutic use)
• Prospective Studies
• Thrombocytopenia (chemically induced, epidemiology)
• Triage