Impact of heparin-induced thrombocytopenia on acute coronary artery thrombosis in patients undergoing PCI

Maeda, Takuma; Noguchi, Teruo; Saito, Shin; Yoshioka, Rei; Horibe, Eishun; Miyanaga, Sunao; Seguchi, Shu; Kanaumi, Yoshiaki; Kawai, Takeshi; Okazaki, Hitoshi; Miyata, Shigeki

doi:10.1160/th13-11-0936

Cited by 18 publications

(23 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The differential impact of HIT on clinical outcomes has been shown to be greater after surgical than after percutaneous revascularization procedures. 11,12 Although HIT did not result in higher in-hospital mortality in this patient's cohort, it was associated with a substantial increase in major morbidities. HIT was associated with a significantly higher risk of venous thromboembolism and ischemic stroke.…”

Section: Discussionmentioning

confidence: 73%

Clinical and economic burden of heparin-induced thrombocytopenia in hospitalized patients undergoing percutaneous peripheral arterial interventions

et al. 2019

View full text Add to dashboard Cite

Background Percutaneous peripheral arterial intervention (PPAI) patients are at a high risk of developing heparin-induced thrombocytopenia due to the need for repeated and prolonged heparin exposure. We sought to investigate the incidence, outcomes, and economic impact of heparin-induced thrombocytopenia post-PPAI utilizing the National Inpatient Sample. Methods All patients who underwent PPAI (age ≥18 years) from 2007 to 2014 were identified by using ICD-9-CM codes. Patients were then classified into two groups based on the presence or absence of heparin-induced thrombocytopenia during hospitalization. In-hospital outcomes were compared between the two groups after propensity-score matching to account for differences in baseline characteristics. Results Heparin-induced thrombocytopenia was reported in 527 patients (0.23%). After adjusting for patient-level and hospital-level characteristics, in-hospital mortality differences were not significantly different between patients with heparin-induced thrombocytopenia vs. those without heparin-induced thrombocytopenia (odds ratio (OR) 1.02, 95% confidence interval (CI) 0.67 to 1.57, p = 0.951). However, PPAI patients with heparin-induced thrombocytopenia were more likely to develop ischemic stroke (OR 3.84, 95%CI 1.26 to 11.75, p = 0.018), deep venous thrombosis/pulmonary embolism (OR 1.32, 95%CI 0.79 to 1.79, p = 0.078), and acute kidney injury requiring dialysis (OR 4.04, 95%CI 1.72 to 9.50, p = 0.001). Furthermore, post-PPAI patients who developed heparin-induced thrombocytopenia had longer hospitalizations (13.8 vs. 9.8 days, p < 0.0001), higher cost of stay ($62,022 vs. $44,904, p < 0.0001), and higher rates of non-routine home discharges (50.15% vs. 42.19%, p = 0.013). Conclusion Among patients who underwent PPAI, heparin-induced thrombocytopenia was associated with a higher risk of venous thrombosis/pulmonary embolism, ischemic stroke, acute kidney injury requiring dialysis, prolonged hospital stay, and increased cost.

show abstract

Section: Discussionmentioning

confidence: 73%

Clinical and economic burden of heparin-induced thrombocytopenia in hospitalized patients undergoing percutaneous peripheral arterial interventions

et al. 2019

View full text Add to dashboard Cite

show abstract

“…Acute stent thrombosis is reported in up to 0.5–0.7% of cases in the first 24 h after PCI (with either drug-eluting or bare-metal stents) [8]. Several factors have been associated with early stent thrombosis, including residual target lesion thrombus or dissection, stasis, stent underexpansion, or a combination of these [9–13]. Although supportive anticoagulant agents are used in the treatment of such cases, UFA and (rarely) low-molecular-weight heparin or glycoprotein IIb/IIIa receptor blockers have been implicated in the abrupt onset of an adverse immune-mediated reaction of HIT [14,15].…”

Section: Discussionmentioning

confidence: 99%

Missed Heparin-Induced Thrombocytopenia (HIT) Diagnosis in a Patient with Acute Stent Thrombosis

et al. 2019

View full text Add to dashboard Cite

Patient: Male, 74 Final Diagnosis: Heparin-induced thrombocytopenia (HIT) Symptoms: Chest discomfort Medication: Heparin Clinical Procedure: Angioplasty and bypass surgery Specialty: Cardiology Objective: Adverse events of drug therapy Background: Heparin-induced thrombocytopenia (HIT) is a serious complication of heparin therapy, characterized by thrombocytopenia and high risk for venous and arterial thrombosis. Case Report: We report an unusual case of acute stent thrombosis secondary to delayed HIT. A 74-year-old man with non-ST-segment elevation myocardial infarction had a coronary angiography which revealed 2-vessel disease. A bolus of unfractionated heparin (UFH) was administered at admission and he received fondaparinux during his hospitalization. We performed elective percutaneous coronary intervention (PCI) with stents to LAD and LCx. Two hours after PCI, the patient developed acute pulmonary edema, and repeat angiography revealed an occlusive thrombus in the ostial LAD and the LCx. A turbidimetric assay for the rapid detection of plasma anti-PF4/heparin antibodies was negative. After repeated unsuccessful attempts of balloon angioplasty and continuous thrombosis, the patient was transferred for emergency surgical revascularisation and was treated with additional UFH followed by enoxaparin. Platelets decreased gradually to 38 k/μl 7 days after surgery, at which time enoxaparin was replaced with fondaparinux. The subsequent HIT test results were positive. Conclusions: HIT should be considered in patients with multiple recent exposures to anticoagulants, independent of the platelet count, if there are signs and symptoms of thrombosis.

show abstract

“…As the most common complication, thrombocytopenia occurred in 20% of cases in our study. The induction of heparin [27,28] or glycoprotein IIb/IIIa receptor antagonist [29,30] is responsible for thrombocytopenia, along with the mechanical destroy of platelets by IABP counterpulsation in synchrony with the cardiac cycle. Given that the severity and duration of thrombocytopenia presents a notable positive correlation with the utility time, IABP is supposed to be removed as soon as possible after stabilized condition.…”

Section: Discussionmentioning

confidence: 99%

Intra-aortic Balloon Pump Therapy for Anterior ST-elevation Myocardial Infarction with Cardiogenic Shock: An Observational Cohort Study

Zhou

Lyu

Dai

et al. 2019

Preprint

View full text Add to dashboard Cite

Background As a mechanical circulatory assistance, intra-aortic balloon pump (IABP) has been widely used for cardiogenic shock (CS), although recent clinical trials questioned its impact on acute myocardial infarction patients, nothing is hitherto known on the contribution of IABP to CS patients after anterior wall infarction. The aim of this study was to investigate the efficacy and safety of IABP therapy in patients presenting with anterior ST-elevation myocardial infarction (STEMI) complicated by CS.Methods We conducted a retrospective study of 215 consecutive patients presenting with CS after STEMI in the anterior wall between January 2006 and August 2017, including 125 patients in the IABP group and 90 patients in the control group.Results At 30 days, 60 (48.0%) patients in the IABP group and 58 (64.4%) patients in the control group had died (P=0.017). The Kaplan-Meier survival curves showed the cumulative survival rate in the IABP group was consistently higher than control group (P=0.009 by Log-Rank test). Nevertheless, IABP increased the occurrence of thrombocytopenia (21.6% vs. 2.2%, P<0.001) and lower limb complications (20.0% vs. 2.2%, P<0.001) at the same time. Subgroup analyses by Cox regression showed a better trend of prognoses in patients aged less than 60 years old (HR=0.49, 95% CI=0.26-0.91, P=0.025), male (HR=0.53, 95% CI=0.34-0.83, P=0.005), no history of hypertension (HR=0.47, 95% CI=0.26-0.87, P=0.017) and systolic blood pressure less than 80 mm Hg (HR=0.40, 95% CI=0.22-0.73, P=0.009). At 12-month follow-up, all-cause mortality in the IABP group was obviously lower than the control group (52.5% vs. 74.1%, P=0.002), there were no significant differences in other adverse cardiovascular events (P=1.000).Conclusions The combination of IABP use is associated with reduced 30-day and 12-month mortality in patients with anterior STEMI complicated by CS, though thrombocytopenia and lower limb complications are frequently observed.

show abstract

Impact of heparin-induced thrombocytopenia on acute coronary artery thrombosis in patients undergoing PCI

Cited by 18 publications

References 14 publications

Clinical and economic burden of heparin-induced thrombocytopenia in hospitalized patients undergoing percutaneous peripheral arterial interventions

Clinical and economic burden of heparin-induced thrombocytopenia in hospitalized patients undergoing percutaneous peripheral arterial interventions

Missed Heparin-Induced Thrombocytopenia (HIT) Diagnosis in a Patient with Acute Stent Thrombosis

Intra-aortic Balloon Pump Therapy for Anterior ST-elevation Myocardial Infarction with Cardiogenic Shock: An Observational Cohort Study

Contact Info

Product

Resources

About