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

Publication ,  Journal Article
Vora, AN; Chenier, M; Schulte, PJ; Goodman, S; Peterson, ED; Pieper, K; Jolicoeur, ME; Mahaffey, KW; White, H; Wang, TY
Published in: Am Heart J
August 2014

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 × 10(9)/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.

Duke Scholars

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

August 2014

Volume

168

Issue

2

Start / End Page

189 / 96.e1

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Thrombocytopenia
  • Severity of Illness Index
  • Platelet Count
  • Platelet Aggregation Inhibitors
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Humans
  • Hospitalization
 

Citation

APA
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MLA
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Vora, A. N., Chenier, M., Schulte, P. J., Goodman, S., Peterson, E. D., Pieper, K., … Wang, T. Y. (2014). Long-term outcomes associated with hospital acquired thrombocytopenia among patients with non-ST-segment elevation acute coronary syndrome. Am Heart J, 168(2), 189-96.e1. https://doi.org/10.1016/j.ahj.2014.04.010
Vora, Amit N., Michael Chenier, Phillip J. Schulte, Shaun Goodman, Eric D. Peterson, Karen Pieper, Marc E. Jolicoeur, Kenneth W. Mahaffey, Harvey White, and Tracy Y. Wang. “Long-term outcomes associated with hospital acquired thrombocytopenia among patients with non-ST-segment elevation acute coronary syndrome.Am Heart J 168, no. 2 (August 2014): 189-96.e1. https://doi.org/10.1016/j.ahj.2014.04.010.
Vora AN, Chenier M, Schulte PJ, Goodman S, Peterson ED, Pieper K, et al. Long-term outcomes associated with hospital acquired thrombocytopenia among patients with non-ST-segment elevation acute coronary syndrome. Am Heart J. 2014 Aug;168(2):189-96.e1.
Vora, Amit N., et al. “Long-term outcomes associated with hospital acquired thrombocytopenia among patients with non-ST-segment elevation acute coronary syndrome.Am Heart J, vol. 168, no. 2, Aug. 2014, pp. 189-96.e1. Pubmed, doi:10.1016/j.ahj.2014.04.010.
Vora AN, Chenier M, Schulte PJ, Goodman S, Peterson ED, Pieper K, Jolicoeur ME, Mahaffey KW, White H, Wang TY. Long-term outcomes associated with hospital acquired thrombocytopenia among patients with non-ST-segment elevation acute coronary syndrome. Am Heart J. 2014 Aug;168(2):189–96.e1.
Journal cover image

Published In

Am Heart J

DOI

EISSN

1097-6744

Publication Date

August 2014

Volume

168

Issue

2

Start / End Page

189 / 96.e1

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Thrombocytopenia
  • Severity of Illness Index
  • Platelet Count
  • Platelet Aggregation Inhibitors
  • Middle Aged
  • Male
  • Kaplan-Meier Estimate
  • Humans
  • Hospitalization