Long-term outcomes associated with hospital acquired thrombocytopenia among patients with non-ST-segment elevation acute coronary syndrome

Amit N. Vora, Michael Chenier, Phillip J. Schulte, Shaun Goodman, Eric D. Peterson, Karen Pieper, Marc E. Jolicoeur, Kenneth W. Mahaffey, Harvey White, Tracy Y. Wang

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13 Scopus citations

Abstract

Background Acquired thrombocytopenia after a non-ST-segment-elevation-acute coronary syndrome (NSTE-ACS) has been associated with increased in-hospital mortality and hemorrhagic complications, but longer term outcomes are unclear. We examined the association between thrombocytopenia and long-term outcomes after accounting for thrombocytopenia severity and discharge medication use. Methods Data from 7,435 NSTE-ACS patients enrolled in the SYNERGY trial were analyzed. Severe thrombocytopenia was defined as a nadir platelet count <100 × 109/L or a ≥50% drop from baseline. Mild thrombocytopenia was defined as a nadir platelet count between 100 and 149 × 10 9/L with a <50% drop from baseline. The primary outcomes of interest were in-hospital GUSTO moderate-severe bleeding and 1-year mortality. Results Overall, 675 patients (9.1%) developed mild thrombocytopenia and 139 patients (1.9%) developed severe thrombocytopenia. In-hospital bleeding risks were higher in patients with mild (7.7%, adjusted HR 1.63, 95% CI 1.16-2.29) or severe (28.2%, adjusted HR 6.93, 95% CI 4.55-10.56) thrombocytopenia than in patients without thrombocytopenia (5.2%). One-year mortality rates were 6.5%, 8.1%, and 28.1% among patients with no, mild, and severe thrombocytopenia, respectively (log rank P < 0.001) but only severe thrombocytopenia remained significantly associated with increased mortality after adjustment: HR 4.07, 95% CI 2.86-5.78. Patients who developed severe thrombocytopenia were less likely to be discharged on guideline-recommended antiplatelet therapy. The relationship between severe thrombocytopenia and mortality was attenuated by but persisted after adjusting for discharge medication use (HR 2.83, 95% CI 1.49-5.38). Conclusions Thrombocytopenia occurs commonly during the course of NSTE-ACS care; even mild decreases are associated with clinically meaningful bleeding. Patients who developed severe thrombocytopenia were less likely to be discharged on guideline-recommended antiplatelet therapy; this may contribute to their higher associated long-term mortality.

Original languageEnglish (US)
Pages (from-to)189-196.e1
JournalAmerican Heart Journal
Volume168
Issue number2
DOIs
StatePublished - Aug 2014

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Vora, A. N., Chenier, M., Schulte, P. J., Goodman, S., Peterson, E. D., Pieper, K., Jolicoeur, M. E., Mahaffey, K. W., White, H., & Wang, T. Y. (2014). Long-term outcomes associated with hospital acquired thrombocytopenia among patients with non-ST-segment elevation acute coronary syndrome. American Heart Journal, 168(2), 189-196.e1. https://doi.org/10.1016/j.ahj.2014.04.010