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Incidence and prognostic significance of thrombocytopenia in patients treated with prolonged heparin therapy.

Publication ,  Journal Article
Oliveira, GBF; Crespo, EM; Becker, RC; Honeycutt, EF; Abrams, CS; Anstrom, KJ; Berger, PB; Davidson-Ray, LD; Eisenstein, EL; Kleiman, NS ...
Published in: Arch Intern Med
January 14, 2008

BACKGROUND: Despite widespread heparin use in clinical practice, the associated development of thrombocytopenia is an underrecognized and undertreated complication. METHODS: We analyzed data from consecutive hospitalized patients treated with heparin (unfractionated or low molecular weight) for 4 days or longer to determine the incidence, predictors, prognostic significance, and management of "thrombocytopenia," defined as a platelet count less than 150 x 10(9)/L, reduction in platelet count of 50% or more from the admission level, or both. RESULTS: We enrolled 2420 patients (median age, 65.2 years; 43.8% women) in 48 US hospitals. Thrombocytopenia occurred in 881 patients (36.4%; 95% confidence interval [CI], 34.5%-38.3%). Of those who developed thrombocytopenia, 5.1% died, compared with 1.6% of those without thrombocytopenia (odds ratio [OR], 3.4; 95% CI, 2.1-5.6; P< .001). Thrombocytopenia was also associated with greater risk of myocardial infarction (OR, 2.1; 95% CI, 1.5-2.8; P< .001) and congestive heart failure (OR, 1.3; 95% CI, 1.1-1.6; P= .01). After adjustment for important covariates, thrombocytopenia remained an independent predictor of thrombotic and hemorrhagic events. A relative reduction in platelet count of more than 70% was the strongest independent predictor of death (OR, 13.4; 95% CI, 6.5-27.6; P< .001), followed by a relative reduction in platelet count of 50% to 70%, worse Killip class, occurrence of thromboembolic complications, older age, and longer duration of heparin therapy. CONCLUSIONS: Thrombocytopenia occurs frequently after prolonged heparin therapy and is strongly associated with worse short-term clinical outcome. The relative reduction in platelet count is a powerful independent predictor of all-cause mortality in hospitalized patients.

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Published In

Arch Intern Med

DOI

ISSN

0003-9926

Publication Date

January 14, 2008

Volume

168

Issue

1

Start / End Page

94 / 102

Location

United States

Related Subject Headings

  • Time Factors
  • Thrombocytopenia
  • Prognosis
  • Platelet Count
  • Middle Aged
  • Male
  • Incidence
  • Humans
  • Hospital Mortality
  • Heparin
 

Citation

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Oliveira, G. B. F., Crespo, E. M., Becker, R. C., Honeycutt, E. F., Abrams, C. S., Anstrom, K. J., … Complications After Thrombocytopenia Caused by Heparin (CATCH) Registry Investigators, . (2008). Incidence and prognostic significance of thrombocytopenia in patients treated with prolonged heparin therapy. Arch Intern Med, 168(1), 94–102. https://doi.org/10.1001/archinternmed.2007.65
Oliveira, Gustavo B. F., Eric M. Crespo, Richard C. Becker, Emily F. Honeycutt, Charles S. Abrams, Kevin J. Anstrom, Peter B. Berger, et al. “Incidence and prognostic significance of thrombocytopenia in patients treated with prolonged heparin therapy.Arch Intern Med 168, no. 1 (January 14, 2008): 94–102. https://doi.org/10.1001/archinternmed.2007.65.
Oliveira GBF, Crespo EM, Becker RC, Honeycutt EF, Abrams CS, Anstrom KJ, et al. Incidence and prognostic significance of thrombocytopenia in patients treated with prolonged heparin therapy. Arch Intern Med. 2008 Jan 14;168(1):94–102.
Oliveira, Gustavo B. F., et al. “Incidence and prognostic significance of thrombocytopenia in patients treated with prolonged heparin therapy.Arch Intern Med, vol. 168, no. 1, Jan. 2008, pp. 94–102. Pubmed, doi:10.1001/archinternmed.2007.65.
Oliveira GBF, Crespo EM, Becker RC, Honeycutt EF, Abrams CS, Anstrom KJ, Berger PB, Davidson-Ray LD, Eisenstein EL, Kleiman NS, Moliterno DJ, Moll S, Rice L, Rodgers JE, Steinhubl SR, Tapson VF, Ohman EM, Granger CB, Complications After Thrombocytopenia Caused by Heparin (CATCH) Registry Investigators. Incidence and prognostic significance of thrombocytopenia in patients treated with prolonged heparin therapy. Arch Intern Med. 2008 Jan 14;168(1):94–102.

Published In

Arch Intern Med

DOI

ISSN

0003-9926

Publication Date

January 14, 2008

Volume

168

Issue

1

Start / End Page

94 / 102

Location

United States

Related Subject Headings

  • Time Factors
  • Thrombocytopenia
  • Prognosis
  • Platelet Count
  • Middle Aged
  • Male
  • Incidence
  • Humans
  • Hospital Mortality
  • Heparin