The effect of in-hospital acquired thrombocytopenia on the outcome of patients with acute coronary syndromes: A systematic review and meta-analysis.
BACKGROUND
In-hospital acquired thrombocytopenia (TP) is relatively common among patients hospitalized with acute coronary syndromes (ACS). However, its effect on short-term and long-term outcomes has yet to be reviewed systematically.


METHODS
We conducted a systematic review and meta-analysis of clinical studies assessing the relationship between new-onset in-hospital TP and adverse outcomes among ACS patients. MEDLINE, Scopus and the Cochrane Library were searched for eligible studies published before March 20, 2016.


RESULTS
Ten studies reporting on a total of 142,161 ACS patients were identified. 8133 patients showed evidence of new-onset TP during the course of their hospitalization. Compared with patients with normal platelet counts, patients with new-onset TP had a prolonged in-hospital stay, significantly higher risk of both short-term mortality (<30days) (Odds ratio (OR) [95% confidence interval (CI)]: 5.58 [3.63-8.57]) and late death (6months to 1year) (OR [95% CI]: 3.45 [2.35-5.07]), as well as a significantly higher risk of major bleeding events in the first 30days (OR [95% CI]: 6.93 [5.13-9.38]). In addition, risk for other secondary cardiovascular endpoints, including recurrent myocardial infarction, stroke, in-hospital heart failure, stent thrombosis and unplanned revascularization was also significantly higher in the TP versus the no TP group.


CONCLUSIONS
Development of TP during the in-hospital management of ACS patients is a significant predictor of both short- and long-term adverse events, including mortality. In the light of this evidence, clinicians should be cautious and closely monitor abnormal platelet counts that present early following an ACS.
Society of Junior Doctors, Athens, Greece; National and Kapodistrian University of Athens, Faculty of Medicine, Athens, Greece. Electronic address: evoikonomou@sni.gr.
Evangelos K
EK
Oikonomou
Society of Junior Doctors, Athens, Greece.
Theodoros I
TI
Repanas
Society of Junior Doctors, Athens, Greece; Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece.
Christos
C
Papanastasiou
Society of Junior Doctors, Athens, Greece; Aristotle University of Thessaloniki, School of Medicine, Thessaloniki, Greece.
Damianos G
DG
Kokkinidis
Society of Junior Doctors, Athens, Greece; Laboratory of Biomathematics, University of Thessaly School of Medicine, Larissa, Greece.
Michael
M
Miligkos
New York Presbyterian Hospital/Weill Cornell Medical College, Department of Medicine, NY, USA.
Attila
A
Feher
Memorial Sloan Kettering Cancer Center, Cardiology Service, New York, USA.
Dipti
D
Gupta
Society of Junior Doctors, Athens, Greece; New York Presbyterian Hospital/Weill Cornell Medical College, Department of Medicine, NY, USA.
Polydoros N
PN
Kampaktsis
D054058:Acute Coronary Syndrome / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D006470:Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D010976:Platelet Count; D012306:Risk; D013921:Thrombocytopenia / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality
Acute coronary syndrome; Mortality; Myocardial infarction; Thrombocytopenia
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