Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
Am J Cardiol. 2018 Nov 1;122(9):1465-1470. doi: 10.1016/j.amjcard.2018.07.033. Epub 2018 Aug 3.
Little data is available on the bleeding risk and outcomes of cancer patients with chronic thrombocytopenia who underwent cardiac catheterization. We sought to assess the safety of coronary angiography, percutaneous coronary intervention, and antiplatelet therapy in cancer patients with acute coronary syndrome (ACS) and chronic thrombocytopenia. We performed a retrospective study of patients with chronic thrombocytopenia who underwent cardiac catheterization for ACS between November 2009 and November 2015. Preprocedural platelet counts were classified into 3 groups: mild thrombocytopenia (50,000 to 100,000/µL), moderate thrombocytopenia (30,000 to 50,000/µL), and severe thrombocytopenia (<30,000/µL). Postprocedural bleeding complications and overall survival (OS) were recorded. A total of 98 patients were included. Mean platelet count on admission was 47.63 ± 29.85 K/µL. Severe thrombocytopenia was identified in 36 patients (36.7%), moderate thrombocytopenia in 20 patients (20.4%), and mild thrombocytopenia in 42 patients (42.9%). Aspirin therapy (alone or in combination with clopidogrel) was used in 66 patients (67.3%), whereas 27 patients (27.6%) were on dual antiplatelet therapy. One procedure-related retroperitoneal hematoma and 3 procedure-related small hematomas were identified. No cerebrovascular events related to the procedure or the antiplatelet therapy were noted. Moderate thrombocytopenia was associated with decreased OS, whereas aspirin, dual antiplatelet therapy, and statin use showed a trend of improved OS. In conclusion, we suggest that coronary angiography and percutaneous coronary intervention can be performed safely in cancer patients with chronic thrombocytopenia. Aspirin therapy and dual antiplatelet therapy should be considered in cancer patients with chronic thrombocytopenia and ACS.
关于接受心脏导管检查的伴有慢性血小板减少症的癌症患者的出血风险和结局，相关数据很少。我们旨在评估伴有急性冠脉综合征（ACS）和慢性血小板减少症的癌症患者行冠状动脉造影、经皮冠状动脉介入治疗和抗血小板治疗的安全性。我们对 2009 年 11 月至 2015 年 11 月期间因 ACS 接受心脏导管检查的伴有慢性血小板减少症的患者进行了回顾性研究。将术前血小板计数分为 3 组：轻度血小板减少症（50,000 至 100,000/µL）、中度血小板减少症（30,000 至 50,000/µL）和重度血小板减少症（<30,000/µL）。记录术后出血并发症和总生存（OS）。共纳入 98 例患者。入院时平均血小板计数为 47.63 ± 29.85 K/µL。36 例（36.7%）患者存在重度血小板减少症，20 例（20.4%）患者存在中度血小板减少症，42 例（42.9%）患者存在轻度血小板减少症。66 例（67.3%）患者使用阿司匹林治疗（单独或联合使用氯吡格雷），27 例（27.6%）患者接受双联抗血小板治疗。发现 1 例与操作相关的腹膜后血肿和 3 例与操作相关的小血肿。未发现与操作或抗血小板治疗相关的脑血管事件。中度血小板减少症与降低的 OS 相关，而阿司匹林、双联抗血小板治疗和他汀类药物的使用显示出 OS 改善的趋势。总之，我们建议在伴有慢性血小板减少症的癌症患者中安全地进行冠状动脉造影和经皮冠状动脉介入治疗。伴有慢性血小板减少症和 ACS 的癌症患者应考虑使用阿司匹林治疗和双联抗血小板治疗。
