Thrombocytopenia in patients treated with heparin, combination antiplatelet therapy, and intra-aortic balloon pump counterpulsation

J Interv Cardiol. 2008 Aug;21(4):350-6. doi: 10.1111/j.1540-8183.2008.00363.x. Epub 2008 Jun 4.

Abstract

Objectives: Determine the incidence and timing of intra-aortic balloon pump (IABP)-associated thrombocytopenia, if concomitant antiplatelet agents increase the incidence of thrombocytopenia, and the incidence of heparin-induced thrombocytopenia (HIT) in a contemporary IABP population.

Background: Previous studies predate the current practice of treating acute coronary syndrome patients with heparin and aspirin plus thienopyridines and glycoprotein IIb/IIIa receptor antagonists such that data are unavailable to determine if their co-administration worsens IABP-associated thrombocytopenia.

Methods: A retrospective cohort study of adult IABP patients (n = 107) from 2002 to 2006 was performed to determine the indication for and duration of counterpulsation, platelet counts during and for 7 days postcounterpulsation, medications potentially contributing to thrombocytopenia, and HIT antibody results if obtained.

Results: Thrombocytopenia, defined as platelets <150,000/mL or >50% decrease from baseline, occurred in 57.9% of patients. Overall, platelets declined to 60.2 +/- 22.8% of baseline with the mean (+/- standard deviation) nadir on day 2.8 +/- 2.0. Comparing patients who received heparin, aspirin, thienopyridines, and glycoprotein IIb/IIIa antagonists (n = 44) versus heparinized patients +/- aspirin (n = 45), platelet nadirs were 62.7 +/- 20.9% versus 58.3 +/- 23.9% of baseline levels, respectively (P = 0.42). The incidence of HIT was 2.8% in the entire cohort.

Conclusions: IABP-associated thrombocytopenia occurred in 57.9% of this cohort. HIT was diagnosed in 2.8% and should be considered as a diagnosis if platelet counts do not stabilize or continue to fall after 3-4 days of counterpulsation. Increased use of antiplatelet therapy does not impact the degree of thrombocytopenia although the current practice of prompt IABP removal may offset this effect.

MeSH terms

  • Anticoagulants / adverse effects
  • Aspirin / adverse effects
  • Cohort Studies
  • Drug Therapy, Combination
  • Female
  • Heparin / adverse effects*
  • Humans
  • Incidence
  • Intra-Aortic Balloon Pumping / adverse effects*
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors / adverse effects
  • Platelet Count
  • Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors
  • Pyridines / adverse effects
  • Retrospective Studies
  • Risk Factors
  • Thrombocytopenia / chemically induced*
  • Thrombocytopenia / etiology

Substances

  • Anticoagulants
  • Platelet Aggregation Inhibitors
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Pyridines
  • thienopyridine
  • Heparin
  • Aspirin