Department of Internal Medicine, Asante Three Rivers Medical Center, Grants Pass, OR, USA.
University of Arizona, Tucson, AZ, USA.
Ann Hematol. 2024 Sep;103(9):3443-3451. doi: 10.1007/s00277-024-05913-7. Epub 2024 Aug 3.
Patients with immune thrombocytopenia (ITP) admitted for non-ST elevation myocardial infarction (NSTEMI) present a unique therapeutic challenge due to the increased risk of bleeding with antiplatelet and anticoagulation therapies. There is limited evidence studying hospital mortality and complications in this population. The study included a patient cohort from the 2018-2021 National Inpatient Sample database. Propensity score matched NSTEMI patients with and without ITP using a 1:1 matching ratio. Outcomes analyzed were in-hospital mortality, rates of diagnostic angiogram, percutaneous coronary intervention (PCI), acute kidney injury (AKI), congestive heart failure (CHF), cardiogenic shock, cardiac arrest, mechanical ventilation, tracheal intubation, ventricular tachycardia (VT), ventricular fibrillation (VF), major bleeding, need for blood and platelet transfusion, length of stay (LOS), and total hospitalization charges. A total of 1,699,020 patients met inclusion criteria (660,490 females [39%], predominantly Caucasian 1,198,415 (70.5%); mean [SD] age 67, [3.1], including 2,615 (0.1%) patients with ITP. Following the propensity matching, 1,020 NSTEMI patients with and without ITP were matched. ITP patients had higher rates of inpatient mortality (aOR 1.98, 95% CI 1.11-3.50, p 0.02), cardiogenic shock, AKI, mechanical ventilation, tracheal intubation, red blood cells and platelet transfusions, longer LOS, and higher total hospitalization charges. The rates of diagnostic angiogram, PCI, CHF, VT, VF, and major bleeding were not different between the two groups. Patients with ITP demonstrated higher odds of in-hospital mortality for NSTEMI and need for platelet transfusion with no difference in rates of diagnostic angiogram or PCI.
患有免疫性血小板减少症（ITP）的非 ST 段抬高型心肌梗死（NSTEMI）患者由于抗血小板和抗凝治疗出血风险增加，存在独特的治疗挑战。目前，针对该人群的住院死亡率和并发症的研究证据有限。该研究纳入了 2018 年至 2021 年国家住院患者样本数据库中的患者队列。使用 1:1 匹配比，通过倾向评分匹配 ITP 与非 ITP 的 NSTEMI 患者。分析的结局包括院内死亡率、诊断性血管造影术、经皮冠状动脉介入治疗（PCI）、急性肾损伤（AKI）、充血性心力衰竭（CHF）、心源性休克、心脏骤停、机械通气、气管插管、室性心动过速（VT）、心室颤动（VF）、大出血、需要输血和血小板、住院时间（LOS）和总住院费用。共有 1,699,020 名患者符合纳入标准（660,490 名女性[39%]，主要为白种人 1,198,415 名[70.5%]；平均[标准差]年龄 67[3.1]岁，包括 2,615 名[0.1%] ITP 患者。在进行倾向评分匹配后，匹配了 1,020 名有和无 ITP 的 NSTEMI 患者。ITP 患者的住院死亡率（比值比 1.98，95%置信区间 1.11-3.50，p=0.02）、心源性休克、AKI、机械通气、气管插管、红细胞和血小板输血、更长的 LOS 和更高的总住院费用更高。两组间诊断性血管造影术、PCI、CHF、VT、VF 和大出血的发生率无差异。患有 ITP 的 NSTEMI 患者住院死亡率和血小板输血的可能性更高，但诊断性血管造影术或 PCI 的发生率无差异。
