thienopyridine and Thrombocytopenia

Agents with antiplatelet and anticoagulant activity have been proved to be effective in reducing the incidence of complications following acute coronary syndrome, percutaneous coronary intervention, and cardiopulmonary bypass. However, these agents, including heparin, glycoprotein IIb/IIIa receptor inhibitors, and thienopyridines, are associated with increased risk of bleeding and thrombocytopenia and have been administered together with increasing frequency in a variety of cardiovascular settings. Therefore, clinicians must be familiar with the safety and rational use of these potent antithrombotic agents. Clinical features of thrombocytopenia range from bleeding to thrombosis, even death, and therapy is very different depending on the underlying cause. Additionally, patients may sometimes need urgent intervention or surgery. Thus, it is essential to quickly discriminate the etiology and start appropriate therapy. This review highlights the pathogenesis, clinical and laboratory manifestation, differential diagnosis, and treatment of antithrombotic drug-induced thrombocytopenia in cardiovascular diseases.

Topics: Cardiovascular Diseases; Diagnosis, Differential; Drug Monitoring; Fibrinolytic Agents; Heparin; Humans; Platelet Glycoprotein GPIIb-IIIa Complex; Pyridines; Thrombocytopenia

Topics: Angioplasty, Balloon; Anticoagulants; Clinical Trials as Topic; Coronary Disease; Europe; Heparin; Humans; Incidence; Minimally Invasive Surgical Procedures; Platelet Glycoprotein GPIIb-IIIa Complex; Postoperative Complications; Purpura, Thrombotic Thrombocytopenic; Pyridines; Risk Factors; Severity of Illness Index; Syndrome; Thrombocytopenia; Treatment Failure; United States

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.. 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.. 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.. 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.. 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.

Topics: Anticoagulants; Aspirin; Cohort Studies; Drug Therapy, Combination; Female; Heparin; Humans; Incidence; Intra-Aortic Balloon Pumping; Male; Middle Aged; Platelet Aggregation Inhibitors; Platelet Count; Platelet Glycoprotein GPIIb-IIIa Complex; Pyridines; Retrospective Studies; Risk Factors; Thrombocytopenia