Heart Center, Turku University Hospital, and University of Turku, Turku, Finland.
Am J Cardiol. 2013 Aug 15;112(4):493-8. doi: 10.1016/j.amjcard.2013.04.007. Epub 2013 May 11.
Thrombocytopenia is often regarded as a risk factor for bleeding complications in patients undergoing percutaneous coronary intervention (PCI). The risk of mild to moderate baseline and acquired thrombocytopenia on bleeding and thrombotic or thromboembolic complications in patients with atrial fibrillation on oral anticoagulation therapy undergoing PCI, however, remains largely unknown. Management of Patients With Atrial Fibrillation undergoing Coronary Artery Stenting is a multicenter European prospective registry enrolling patients with atrial fibrillation undergoing PCI. We assessed the rate of bleeding complications as defined by Bleeding Academic Research Consortium and a composite of major adverse cardiac and cerebrovascular events (MACCE) including all-cause mortality, myocardial infarction, transient ischemic attack or stroke, stent thrombosis, systemic arterial embolism, or revascularization; and a composite of any harmful event (Bleeding Academic Research Consortium and MACCE) at 12-month follow-up in 861 consecutive patients undergoing PCI. Patients were divided into those with mild to moderate baseline thrombocytopenia (platelet count <150 × 10⁹/L; n = 99) and control group (platelet count >150 × 10⁹/L; n = 762). At hospital discharge, thrombocytopenia had no effect on prescribed antithrombotic treatment, and triple therapy (vitamin K antagonist + aspirin + clopidogrel) was the most common combination in both patient groups (69% vs 73%, p = 0.40). No differences in all-cause mortality (12% vs 11%, p = 0.79), MACCE (23% vs 22%, p = 0.87), or bleeding complications (23% vs 19%, p = 0.26) were detected. Acquired in-hospital thrombocytopenia occurred in 9.7% of patients, and it was associated with similar risk of adverse outcomes compared with control group. In conclusion, mild to moderate baseline thrombocytopenia does not seem to have a clinically significant effect on bleeding or thrombotic or thromboembolic complications after PCI in these frail patients receiving multiple antithrombotic drugs.
血小板减少症通常被认为是接受经皮冠状动脉介入治疗 (PCI) 的患者发生出血并发症的危险因素。然而，在接受口服抗凝治疗的房颤患者中，基线轻度至中度血小板减少症以及获得性血小板减少症与出血以及血栓形成或血栓栓塞并发症之间的关系，以及接受 PCI 的房颤患者的管理，在很大程度上仍不清楚。接受冠状动脉支架置入术的房颤患者管理是一项多中心欧洲前瞻性注册研究，纳入了接受 PCI 的房颤患者。我们评估了出血并发症的发生率，其定义为 Bleeding Academic Research Consortium 和主要不良心脏和脑血管事件 (MACCE) 的复合终点，包括全因死亡率、心肌梗死、短暂性脑缺血发作或中风、支架血栓形成、系统性动脉栓塞或血运重建；以及 12 个月随访时的任何有害事件 (Bleeding Academic Research Consortium 和 MACCE) 的复合终点，共纳入 861 例连续接受 PCI 的患者。患者分为基线轻度至中度血小板减少症（血小板计数 <150×10⁹/L；n=99）和对照组（血小板计数>150×10⁹/L；n=762）。在出院时，血小板减少症对规定的抗血栓治疗没有影响，并且双联抗血小板治疗（维生素 K 拮抗剂+阿司匹林+氯吡格雷）是两组患者最常见的组合（69%比 73%，p=0.40）。两组患者的全因死亡率（12%比 11%，p=0.79）、MACCE（23%比 22%，p=0.87）或出血并发症（23%比 19%，p=0.26）均无差异。住院期间获得性血小板减少症发生在 9.7%的患者中，与对照组相比，其不良结局的风险相似。总之，在接受多种抗血栓药物治疗的这些脆弱患者中，基线轻度至中度血小板减少症似乎对 PCI 后的出血或血栓形成或血栓栓塞并发症没有明显的临床影响。
