title: Incidence and clinical consequences of acquired thrombocytopenia after antithrombotic therapies in patients with acute coronary syndromes: results from the Acute Catheterization and Urgent Intervention Triage Strategy (ACUITY) trial.
abstract: BACKGROUND
  The aim of the study was to investigate the incidence and clinical consequences of acquired thrombocytopenia in patients with acute coronary syndromes (ACS) in the ACUITY trial.
  
  
  METHODS
  We examined 10,836 patients with ACS randomized to receive heparin plus glycoprotein (GP) IIb/IIIa inhibitor, bivalirudin plus GP IIb/IIIa inhibitor, or bivalirudin monotherapy.
  
  
  RESULTS
  Acquired thrombocytopenia developed in 740 (6.8%) patients; mild (100,000-150,000 platelets/mm³), moderate (50,000-100,000 platelets/mm³), and severe (< 50,000 platelets/mm³) developed in 656 (6%), 51 (0.5%), and 33 (0.3%) patients, respectively. Patients with acquired thrombocytopenia, compared with those without, were more likely to develop major bleeding (14% vs 4.3%, P < .0001) at 30 days and had higher rates of mortality (6.5% vs 3.4%, P < .0001) at 1 year. By multivariate analysis, acquired thrombocytopenia was an independent predictor of major bleeding at 30 days (hazard ratio [HR] 1.68, 95% CI 1.04-2.72, P = .03). Moderate and severe acquired thrombocytopenia were predictors of mortality at 1 year (HR 2.89, 95% CI 0.92-9.06, P = .06, and HR 3.41, 95% CI 1.09-10.68, P = .03, respectively). Compared to heparin plus GP IIb/IIIa inhibitor, bivalirudin monotherapy was associated with less declines in platelet count by >25% (7.6% vs 5.6%, P = .0009) and >50% (1.4% vs 0.7%, P = .004) from baseline.
  
  
  CONCLUSIONS
  Acquired thrombocytopenia occurs in approximately 1 in 14 patients with ACS treated with antithrombin and antiplatelet medications and is strongly associated with hemorrhagic and ischemic complications. Compared to an anticoagulant regimen including a GP IIb/IIIa inhibitor, administration of bivalirudin monotherapy appears to be associated with less frequent declines in platelet count.
authors.affiliation: Cardiovascular Research Foundation, New York, NY, USA.
authors.forename: Adriano
authors.initials: A
authors.lastname: Caixeta
authors.forename: George D
authors.initials: GD
authors.lastname: Dangas
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Frederick
authors.initials: F
authors.lastname: Feit
authors.forename: Eugenia
authors.initials: E
authors.lastname: Nikolsky
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: Jiro
authors.initials: J
authors.lastname: Aoki
authors.forename: Jeffrey W
authors.initials: JW
authors.lastname: Moses
authors.forename: Steven R
authors.initials: SR
authors.lastname: Steinhubl
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
authors.forename: E Magnus
authors.initials: EM
authors.lastname: Ohman
authors.forename: Steven V
authors.initials: SV
authors.lastname: Manoukian
authors.forename: Martin
authors.initials: M
authors.lastname: Fahy
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000628:therapy; D000368:Aged; D006328:Cardiac Catheterization; D004638:Emergency Treatment; D005260:Female; D005343:Fibrinolytic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D011446:Prospective Studies; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000453:epidemiology*; D014218:Triage
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors