Incidence and prognostic significance of thrombocytopenia in patients treated with prolonged heparin therapy

Gustavo B.F. Oliveira, Eric M. Crespo, Richard C. Becker, Emily F. Honeycutt, Charles S. Abrams, Kevin J. Anstrom, Peter B. Berger, Linda D. Davidson-Ray, Eric L. Eisenstein, Neal S. Kleiman, David J. Moliterno, Stephan Moll, Lawrence Rice, Jo E. Rodgers, Steven R. Steinhubl, Victor F. Tapson, E. Magnus Ohman, Christopher B. Granger

Research output: Contribution to journalArticle

85 Scopus citations

Abstract

Background: Despite widespread heparin use in clinical practice, the associated development of thrombocytopenia is an underrecognized and undertreated complication. Methods: We analyzed data from consecutive hospitalized patients treated with heparin (unfractionated or low molecular weight) for 4 days or longer to determine the incidence, predictors, prognostic significance, and management of "thrombocytopenia," defined as a platelet count less than 150 × 109/L, reduction in platelet count of 50% or more from the admission level, or both. Results: We enrolled 2420 patients (median age, 65.2 years; 43.8% women) in 48 US hospitals. Thrombocytopenia occurred in 881 patients (36.4%; 95% confidence interval [CI], 34.5%-38.3%). Of those who developed thrombocytopenia, 5.1% died, compared with 1.6% of those without thrombocytopenia (odds ratio [OR], 3.4; 95% CI, 2.1-5.6; P<.001). Thrombocytopenia was also associated with greater risk of myocardial infarction (OR, 2.1; 95% CI, 1.5-2.8; P<.001) and congestive heart failure (OR, 1.3; 95% CI, 1.1-1.6; P=.01). After adjustment for important covariates, thrombocytopenia remained an independent predictor of thrombotic and hemorrhagic events. A relative reduction in platelet count of more than 70% was the strongest independent predictor of death (OR, 13.4; 95% CI, 6.5-27.6; P<.001), followed by a relative reduction in platelet count of 50% to 70%, worse Killip class, occurrence of thromboembolic complications, older age, and longer duration of heparin therapy. Conclusions: Thrombocytopenia occurs frequently after prolonged heparin therapy and is strongly associated with worse short-term clinical outcome. The relative reduction in platelet count is a powerful independent predictor of all-cause mortality in hospitalized patients.

Original languageEnglish (US)
Pages (from-to)94-102
Number of pages9
JournalArchives of Internal Medicine
Volume168
Issue number1
DOIs
StatePublished - Jan 14 2008

ASJC Scopus subject areas

  • Internal Medicine

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