Platelet count and outcome in patients with acute venous thromboembolism.
The relationship between platelet count and outcome in patients with acute venous thromboembolism (VTE) has not been consistently explored. RIETE is an ongoing registry of consecutive patients with acute VTE. We categorised patients as having very low- (<80,000/µl), low- (80,000/µl to 150,000/µl), normal- (150,000/µl to 300,000/µl), high- (300,000/µl to 450,000/µl), or very high (>450,000/µl) platelet count at baseline, and compared their three-month outcome. As of October 2012, 43,078 patients had been enrolled in RIETE: 21,319 presenting with pulmonary embolism and 21,759 with deep-vein thrombosis. In all, 502 patients (1.2%) had very low-; 5,472 (13%) low-; 28,386 (66%) normal-; 7,157 (17%) high-; and 1,561 (3.6%) very high platelet count. During the three-month study period, the recurrence rate was: 2.8%, 2.2%, 1.8%, 2.1% and 2.2%, respectively; the rate of major bleeding: 5.8%, 2.6%, 1.7%, 2.3% and 4.6%, respectively; the rate of fatal bleeding: 2.0%, 0.9%, 0.3%, 0.5% and 1.2%, respectively; and the mortality rate: 29%, 11%, 6.5%, 8.8% and 14%, respectively. On multivariate analysis, patients with very low-, low-, high- or very high platelet count had an increased risk for major bleeding (odds ratio [OR]: 2.70, 95% confidence interval [CI]: 1.85-3.95; 1.43 [1.18-1.72]; 1.23 [1.03-1.47]; and 2.13 [1.65-2.75]) and fatal bleeding (OR: 3.70 [1.92-7.16], 2.10 [1.48-2.97], 1.29 [0.88-1.90] and 2.49 [1.49-4.15]) compared with those with normal count. In conclusion, we found a U-shaped relationship between platelet count and the three-month rate of major bleeding and fatal bleeding in patients with VTE.
Prof. Manuel Monreal, MD, PhD, Servicio de Medicina Interna, Hospital Universitari Germans Trias i Pujol, 08916 Badalona, Barcelona, Spain, Tel.: +34 669675313, E-mail: mmonreal.germanstrias@gencat.cat.
Pierpaolo
P
Di Micco
Nuria
N
Ruiz-Giménez
José Antonio
JA
Nieto
Drahomir
D
Aujesky
Fátima
F
del Molino
Reina
R
Valle
Manuel
M
Barrón
Ana
A
Maestre
Manuel
M
Monreal
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D001792:Blood Platelets / Q000473:pathology*; D002452:Cell Count; D005260:Female; D006470:Hemorrhage; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality; D012042:Registries; D012306:Risk; D013921:Thrombocytopenia / Q000453:epidemiology*; D013922:Thrombocytosis / Q000453:epidemiology*; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000097:blood* / Q000453:epidemiology* / Q000401:mortality
Platelet count; bleeding; mortality; venous thromboembolism