Impact of aspirin therapy in cancer patients with thrombocytopenia and acute coronary syndromes.
BACKGROUND
Patients with cancer who have thrombocytopenia may experience acute coronary syndromes (ACS), and the use of aspirin (ASA) poses an increased risk of bleeding. The purpose of this study was to test the hypothesis that the benefit of ASA therapy in the treatment of ACS would extend to cancer patients with thrombocytopenia and outweigh the risks of severe bleeding.


METHODS
The records of all cancer patients diagnosed with an ACS in 2001 and referred for cardiology consultation were reviewed. Patients were divided into 2 groups on the basis of platelet count, >100 cells k/microL and < or = 100 cells k/microL. Data were collected on the use of ASA therapy, bleeding complications, and survival rates. The authors assessed group differences by using the Wilcoxon rank sum test or 2-tailed Fisher exact test, as appropriate. Univariate and multivariate logistic regression models were used to assess factors potentially associated with 7-day survival.


RESULTS
In cancer patients with ACS and thrombocytopenia, those who did not receive ASA had a 7-day survival rate of 6% compared with 90% in those who did receive ASA (P < .0001). There were no severe bleeding complications. Patients with a platelet count (>100 cells k/microL) who received ASA had a 7-day survival rate of 88% compared with 45% in those who did not receive ASA (P = .0096).


CONCLUSIONS
Therapy with ASA was associated with a significantly improved 7-day survival after ACS in cancer patients, with or without thrombocytopenia, and not associated with more severe bleeding.
Sarkiss
Mona G
MG
Department of Anesthesiology, University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA.
Yusuf
S Wamique
SW
Warneke
Carla L
CL
Botz
Gregory
G
Lakkis
Nasser
N
Hirch-Ginsburg
Cheryl
C
Champion
J Chris
JC
Swafford
Joseph
J
Shaw
Andrew D S
AD
Lenihan
Daniel J
DJ
Durand
Jean-Bernard
JB
D000208:Acute Disease; D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D003327:Coronary Disease / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D006470:Hemorrhage / Q000150:complications; D006801:Humans; D008297:Male; D008499:Medical Records; D009203:Myocardial Infarction / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D009369:Neoplasms / Q000150:complications*; D017063:Outcome Assessment, Health Care; D010976:Platelet Count; D012189:Retrospective Studies; D015996:Survival Rate; D013921:Thrombocytopenia / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*
D000894:Anti-Inflammatory Agents, Non-Steroidal; D001241:Aspirin