title: Effects of baseline and early acquired thrombocytopaenia on long-term mortality in patients undergoing percutaneous coronary intervention with bivalirudin.
abstract: OBJECTIVE
  Bivalirudin use as a procedural anticoagulant in patients undergoing percutaneous coronary intervention (PCI) is associated with a lower incidence of thrombocytopaenia compared to other antithrombotic agents. We aimed to evaluate the prognostic impact of baseline thrombocytopaenia and early changes in platelet counts among patients undergoing PCI with exclusive use of bivalirudin.
  
  
  RESULTS
  We evaluated 7,505 patients who underwent PCI over a period of eight years. Patients who received unfractionated heparin and glycoprotein IIb/IIIa receptor inhibitors were specifically excluded. Eight hundred and fifty-eight (11.4%) patients had baseline thrombocytopaenia and 451 (6.0%) developed acquired thrombocytopaenia. After adjustment for potential covariates, moderate to severe acquired thrombocytopaenia was the strongest independent predictor (HR 4.34, 95% CI: 2.13-8.84; p<0.001) of in-hospital net adverse clinical events, which included major adverse cardiac events and major bleeding complications. Age, male gender, baseline platelet count and intra-aortic balloon pump (IABP) insertion were independent predictors of in-hospital acquired thrombocytopaenia. After a mean follow-up of 2.6±1.7 years, moderate to severe baseline thrombocytopaenia (HR 2.42, 95% CI: 1.79-3.29; p<0.001), moderate to severe acquired thrombocytopaenia (HR 2.37, 95% CI: 1.13-4.97; p=0.02) and severe changes in platelet count (>67 k) were significant predictors of mortality.
  
  
  CONCLUSIONS
  In patients undergoing PCI with bivalirudin, moderate to severe baseline and acquired thrombocytopaenia along with severe changes in platelet count are associated with higher long-term mortality.
authors.affiliation: Division of Cardiology, Mount Sinai School of Medicine, New York, NY, USA.
authors.forename: Ziad A
authors.initials: ZA
authors.lastname: Ali
authors.forename: Yasir H
authors.initials: YH
authors.lastname: Qureshi
authors.forename: Keyvan
authors.initials: K
authors.lastname: Karimi Galougahi
authors.forename: Shyam
authors.initials: S
authors.lastname: Poludasu
authors.forename: Swathi
authors.initials: S
authors.lastname: Roye
authors.forename: Prakash
authors.initials: P
authors.lastname: Krishnan
authors.forename: Adrian
authors.initials: A
authors.lastname: Zalewski
authors.forename: Zainab Z
authors.initials: ZZ
authors.lastname: Shah
authors.forename: Navdeep
authors.initials: N
authors.lastname: Bhatti
authors.forename: Kumar
authors.initials: K
authors.lastname: Kalapatapu
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: George
authors.initials: G
authors.lastname: Dangas
authors.forename: Annapoorna S
authors.initials: AS
authors.lastname: Kini
authors.forename: Samin K
authors.initials: SK
authors.lastname: Sharma
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D000925:Anticoagulants / Q000627:therapeutic use; D000991:Antithrombins / Q000627:therapeutic use*; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006629:Hirudins; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000627:therapeutic use*; D062645:Percutaneous Coronary Intervention / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011994:Recombinant Proteins / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000188:drug therapy* / Q000401:mortality; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011994:Recombinant Proteins; D006493:Heparin; C074619:bivalirudin