Sheng Z, Zhao H, Yan H, Jiang S, Guan Y, Zhang Y, Song L, Liu C, Zhou P, Liu K, Liu J, Tan Y
Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 167, Beilishi Road, 100037, Xicheng District, Beijing, China.
Herz. 2018 Sep;43(6):555-564. doi: 10.1007/s00059-017-4599-5. Epub 2017 Jul 19.
Thrombocytopenia is a frequently encountered phenomenon during intra-aortic balloon pumping (IABP), which may limit its prolonged utilization. The aim of the study was to explore the risk factors and clinical implications of IABP-associated thrombocytopenia in patients with acute coronary syndrome (ACS).
We retrospectively analyzed the data of 222 patients with ACS undergoing invasive treatment strategy supported by IABP. The incidence and risk factors of IABP-associated thrombocytopenia, and the association between thrombocytopenia and relevant clinical endpoints (in-hospital death, bleeding according to the TIMI scale, and thromboembolic events), were analyzed.
IABP-associated thrombocytopenia was observed in 54.5% (121/222) of the patients. The incidence of thrombocytopenia was higher and the magnitude of reduction in platelet count was greater in the Arrow balloon group (n = 89) compared with the Datascope balloon group (n = 133; 68.5% vs. 45.1%, p = 0.001; 48.7% vs. 33.2%, p < 0.001; respectively). Independent predictors of thrombocytopenia included older age and Arrow balloon utilization (odds ratio [OR]: 1.054; 95% confidence interval [CI]: 1.028-1.080; p<0.001; OR: 2.468; 95%CI: 1.375-4.431; p = 0.002; respectively). The incidence of in-hospital death was higher in patients who developed thrombocytopenia than those who did not (9.1% vs. 2.0%, p = 0.041), and thrombocytopenia was correlated with in-hospital death (OR: 5.932; 95%CI: 1.221-28.822; p = 0.027). However, the rates of TIMI bleeding and thromboembolic events were similar between the two groups (5.8% vs. 5.0%, p = 1.000; 3.2% vs. 6.0%, p = 0.518; respectively), and thrombocytopenia was not associated with TIMI bleeding or thromboembolic events (OR: 0.940; 95%CI: 0.267-3.307; p = 0.923; OR: 0.541, 95%CI: 0.148-1.974, p = 0.352; respectively).
IABP-associated thrombocytopenia occurred in 54.5% of patients with ACS undergoing an invasive strategy and it was correlated with increased in-hospital mortality. Older age and use of the Arrow balloon may predict IABP-associated thrombocytopenia.
血小板减少症是主动脉内球囊反搏（IABP）过程中经常遇到的现象，这可能会限制其长期使用。本研究的目的是探讨急性冠状动脉综合征（ACS）患者IABP相关血小板减少症的危险因素及临床意义。
我们回顾性分析了222例接受IABP支持的侵入性治疗策略的ACS患者的数据。分析了IABP相关血小板减少症的发生率和危险因素，以及血小板减少症与相关临床终点（院内死亡、根据TIMI量表评估的出血和血栓栓塞事件）之间的关联。
54.5%（121/222）的患者出现IABP相关血小板减少症。与Datascope球囊组（n = 133）相比，Arrow球囊组（n = 89）的血小板减少症发生率更高，血小板计数降低幅度更大（分别为68.5%对45.1%，p = 0.001；48.7%对33.2%，p < 0.001）。血小板减少症的独立预测因素包括年龄较大和使用Arrow球囊（比值比[OR]：1.054；95%置信区间[CI]：1.028 - 1.080；p < 0.001；OR：2.468；95%CI：1.375 - 4.431；p = 0.002）。发生血小板减少症的患者院内死亡率高于未发生者（9.1%对2.0%，p = 0.041），且血小板减少症与院内死亡相关（OR：5.932；95%CI：1.221 - 28.822；p = 0.027）。然而，两组之间的TIMI出血率和血栓栓塞事件发生率相似（分别为5.8%对5.0%，p = 1.000；3.2%对6.0%，p = 0.518），且血小板减少症与TIMI出血或血栓栓塞事件无关（OR：0.940；95%CI：0.267 - 3.307；p = 0.923；OR：0.
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