Key result
Advanced thrombocytopenia (≤85×10^9/L) in patients undergoing PCI was associated with a higher risk of in-hospital death, bleeding, or transfusion (OR 1.67; 95% CI 1.06-2.65; p=0.029).
Why the study?
Although thrombocytopenia is considered to increase bleeding risk and comorbidities after PCI, existing results are controversial and its real-world clinical impact remains largely unknown.
Does baseline thrombocytopenia increase the risk of adverse in-hospital outcomes in patients undergoing PCI?
Cohort (n=9,531)
No
Does baseline thrombocytopenia increase the risk of adverse in-hospital outcomes in patients undergoing PCI?
Odds Ratio: 1.67 (95% CI 1.06–2.65)
p-value: p=0.029
While mild thrombocytopenia does not significantly worsen in-hospital outcomes post-PCI, advanced thrombocytopenia (≤ 85 × 10^9/L) and the use of ticagrelor in ACS patients with thrombocytopenia significantly increase bleeding risks.
PCI feasible with baseline thrombocytopenia; observational data leave open risks with advanced thrombocytopenia, ACS, and potent P2Y12 inhibitors.
Background. Thrombocytopenia was intuitively considered to be associated with higher risk of bleeding and multiple comorbidities after percutaneous coronary intervention (PCI). However, controversial results exist, and the real-world clinical impact of thrombocytopenia in patients undergoing PCI is largely unknown. The aim of this study was to evaluate the influence of baseline thrombocytopenia on the prognosis of patients undergoing PCI. Methods. Using the West China Hospital Inpatient Sample database, patients who underwent PCI were identified from August 2012 to January 2019. Baseline thrombocytopenia was defined as a preprocedural platelet count of 100 × 10 9 / L or less obtained from a routine blood sample taken within 48 hours before coronary PCI. The clinical effect of the advanced thrombocytopenia group ( ≤ 85 × 10 9 / L ), according to the median value of platelet count in the thrombocytopenia cohort, was further assessed. The primary outcome was a composite of in-hospital death, bleeding events, and post-PCI transfusion. Results. Of 9531 patients enrolled in our study, 936 had baseline thrombocytopenia and 8595 patients did not have. There were no significant differences in the primary outcome between the two groups. However, advanced thrombocytopenia was independently associated with higher risk of primary outcome (OR 1.67, 95% CI 1.06 to 2.65, p = 0.029 ). Acute coronary syndrome (ACS) patients with thrombocytopenia were associated with higher odds of major bleeding ( BARC ≥ 2 ) (OR 2.56, 95% CI 1.24 to 5.44, p = 0.011 ). Compared with the nonthrombocytopenia group, the thrombocytopenia group with ticagrelor use had higher odds of major bleeding (OR 9.7, 95% CI 1.57 to 60.4 versus OR 0.22, 95% CI 0.03 to 1.69, interaction p = 0.025 ). Conclusions. It seems feasible for patients with thrombocytopenia to receive PCI, but close attention should be paid to advanced thrombocytopenia, the risk of postprocedure bleeding in ACS patients, and the use of more potent P2Y12 inhibitor.
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Chen et al. (2021) conducted a cohort in Patients undergoing percutaneous coronary intervention (PCI) (n=9,531). Baseline thrombocytopenia vs. Nonthrombocytopenia was evaluated on Composite of in-hospital death, bleeding events, and post-PCI transfusion (OR 1.67, 95% CI 1.06 to 2.65, p=0.029). Advanced thrombocytopenia (≤85×10^9/L) in patients undergoing PCI was associated with a higher risk of in-hospital death, bleeding, or transfusion (OR 1.67; 95% CI 1.06-2.65; p=0.029).
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