Table 6.
Outcome Studies on Patients With Baseline TP and Acute Major Arterial Vascular Events
| References | Study Design and Population | TP Degree and Origin | Ongoing APT | Bleeding Incidence | Thrombosis Incidence | Mortality |
|---|---|---|---|---|---|---|
| Sarkiss et al169 | Observational, retrospective; ACS cancer patients with or without TP | TP: <100 × 109/L (median 32 × 109/L), n = 47 Non-TP: >100 × 109/L, n = 43 |
ASA: 37% TP patients, 74% of non-TP patients | No differences in major bleeding in patients off vs on ASA. More bleeding on TP patients, but ASA-unrelated |
NA | Overall 7-d death higher in no ASA vs ASA: OR 18.44 [2.87–118.60] Lack of beta-blocker use also associated with higher mortality |
| Overgaard et al145 | Observational, retrospective; elective and urgent PCI | TP: <150 × 109/L, n = 639, various origin; Non-TP: ≥150 × 109/L, n = 10,182 |
Same DAPT/SAPT in TP and non-TP patients | Major bleeding: 1.7% TP vs 0.8% non-TP, P < 0.01 GI bleeding: 1.1% TP vs 0.5% non-TP, P < 0.05 |
NA | In-hospital mortality: 1.9% TP vs 0.6% non-TP, P < 0.01, mostly for urgent PCI OR 2.07; 95% CI, 1.1-4.1 |
| Hakim et al19 | Subgroups of RCT; STEMI patients undergoing PCI with and w/out TP at baseline |
TP: <150 × 109/L, n = 146; various origin Non-TP ≥ 150 × 109/L, n = 3330 |
ASA: 98% at discharge in TP and non-TP Clopidogrel: 85.4% TP vs 92% non-TP, P < 0.05 |
Major bleeding: TP 15.4%, non-TP 9.1%, P = 0.01 | 2-y MACE: TP 24.7%, non-TP 18.5%, P = 0.03 | 2 y all-cause mortality: TP: 11.3%, non-TP 5.1%, P < 0.01; ASA at discharge: HR for 2-y mortality: 0.23 [0.09-0.59] |
| Sico et al159 | Retrospective, Cohort Stroke patients |
TP: <100 × 109/L, n = 28; Various origin Non-TP: >100 × 109/L, n = 1205 |
NA | Symptomatic poststroke intracranial bleeding: TP vs no TP: OR 17.6 [4.6-67] | NA | In-hospital mortality TP vs non-TP: OR 6.6 [2.3-18.6] |
| Yadav et al146 | Subgroup of 2 randomized trials; NSTEMI and STEMI patients | TP: 100–150 × 109/L, n = 607, various origin Non-TP: >150 × 109/L, n = 9996 |
Aspirin 98% of both groups; Thienopyridine: 77% non-TP vs 73% TP, P = 0.03 |
NA | TP independent predictor of MACE: HR 1.39 [1.09-1.7] and ischemic TLR HR: 1.37 [1.04-1.81] | TP independent predictor of 1-y all-cause mortality: HR 1.74 [1.12-2.69] |
| Feher et al20 | Observational, retrospective, MI patients with hematologic cancers | Mild TP: >50 × 109/L, n = 58 Severe TP: ≤50 × 109/L, n = 61 Cancer-related TP |
ASA: 43% severe TP, 83% mild TP Thienopyridine: 3% severe TP, 27% mild TP |
No difference in BARC 3–5 bleeding in the 2 groups | NA | Severe TP on ASA had improved survival at 7 d, 1 and 3 y vs severe TP w/out ASA, P = 0.008 |
| Iliescu et al163 | Observational, retrospective, ACS patients with cancer | TP: <100 × 109/L, n = 98 as follows: 50–100 × 109/L, n = 36; 30–50 × 109/L, n = 20; <30 × 109/L, n = 42 Cancer-related TP |
No APT: 30.6% SAPT: 41.8% DAPT: 27.6% ASA (SAPT or DAPT): 67.3% Clopidogrel (SAPT or DAPT) 29.6% |
No major bleeding over 72 mo | NA | Overall and CV mortality higher at lower platelet counts. Statins, ASA alone and DAPT associated with a trend of longer survival (P = 0.06) |
| Shiraishi et al206 | Observational, retrospective; elective PCI |
TP: 50–149 × 109/L, n = 226 as follows TP mild: 100–149 × 109/L, n = 187 TP moderate: 50–99 × 109/L, n = 39; various origin non-TP: 150–449 × 109/L, n = 1009 |
ASA: 87% in both TP and non-TP (moderate TP: 82%) Thienopyridines: 80% non-TP vs 73% TP (P < 0.05) (moderate TP 84.6%) DAPT: non-TP 75%, TP: 68.9% (P = 0.058) |
No other differences in bleeding Access bleeding higher in moderate TP vs non-TP, OR 6.5 [1.7–24.2] |
No differences in MACE | No differences in mortality among TP and non-TP and among TP mild and moderate |
| Long et al24 | Meta-analysis, post-PCI (STEMI and NSTEMI) with TP at baseline | TP <100 × 109/L, n = 37,753 Non-TP n = 81,192, various origins |
DAPT | Postprocedural bleeding, GI bleeding, intracranial bleeding, major bleeding significantly higher in the TP group | MACE significantly higher in the TP group, whereas stent thrombosis was similar | NA |
| Liu et al207 | Registry, STEMI patients, TP at baseline | TP <100 × 109/L n = 364, various origin, as follows: 50–100 × 109/L, n = 313; <50 × 109/L, n = 51 non-TP, n = 16,593 |
ASA approximately 92% in TP and non-TP P2Y12 receptor antagonist approximately 98% in TP and non-TP P = ns |
NA | Multivariable analysis showed no association between TP and MACE (HR 1.21 [0.89–1.63]) | Multivariable analysis showed no association between 2-y all-cause death and TP, HR 1.21 [0.88-1.67] |
ACS = acute coronary syndromes; ASA = aspirin; CV = cardiovascular; DAPT = dual antiplatelet therapy; GI = gastrointestinal; HR = hazard ratio; MACE = major adverse cardiovascular events; MI = myocardial infarction; NA = not available; ns = nonsignificant; OR = odds ratio; PCI = percutaneous coronary intervention; STEMI = ST elevation myocardial infarction; TP = thrombocytopenia.