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World J Meta-Anal. May 26, 2014; 2(2): 24-28
Published online May 26, 2014. doi: 10.13105/wjma.v2.i2.24
Prognostic significance of post percutaneous coronary intervention thrombocytopenia
Michele Schiariti, Loredana Iannetta, Concetta Torromeo, Michele De Gregorio, Paolo Emilio Puddu
Michele Schiariti, Loredana Iannetta, Concetta Torromeo, Paolo Emilio Puddu, Laboratory of Biotechnologies Applied to Cardiovascular Medicine, Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatrical Sciences, Sapienza University of Rome, 00161 Rome, Italy
Michele De Gregorio, Department of Medicine, St. Joseph Mercy Oakland Hospital, Pontiac, MI 48341, United States
Author contributions: All the authors contributed equally to this work.
Correspondence to: Paolo Emilio Puddu, MD, PhD, FESC, FACC, Laboratory of Biotechnologies Applied to Cardiovascular Medicine, Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatrical Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161 Rome, Italy. paoloemilio.puddu@uniroma1.it
Telephone: +39-6-49972654 Fax: +39-6-4453891
Received: November 5, 2013
Revised: January 25, 2014
Accepted: February 18, 2014
Published online: May 26, 2014
Abstract

Several definitions of post percutaneous coronary intervention (PCI) thrombocytopenia (TC) were formulated. Recent studies demonstrated that a relative drop in platelet count ≥ 25% is the most appropriate criterion. By this definition a population is detected that is exposed not only to increased risk of hemorrhagic complications but also to increased risk of ischemic events, which may appear a paradox. In patients with acute coronary syndromes undergoing PCI, several conditions might be associated with TC: cardiopulmonary by-pass and the presence of extra corporeal membrane oxygenators, intra aortic balloon pump (IABP), cardiogenic shock, thrombolytic drugs and anticoagulant or antiplatelet drugs. Several studies demonstrated that TC and ischemic outcomes are related although it is unclear whether this is a direct relationship or TC is just a secondary effect of another cryptic protagonist. It is suggested that further investigations determine whether there is a real link between TC, a probably well defined covariate, and ischemic outcomes or whether IABP is the joining link between these two variables and whose presence needs in any case be considered in multivariable statistics. Post-PCI TC could be only a secondary effect of IABP use. On turn, the prolonged use of heparin necessarily accompanying the use of IABP, and producing a paradoxical pro-thrombotic TC, might also be implicated.

Keywords: Thrombocytopenia, Outcome, Percutaneous coronary intervention, Intra aortic balloon pump

Core tip: This minireview suggested that further investigations are needed to determine whether there is a real link between thrombocytopenia (TC), a probably well defined covariate, and ischemic outcomes or whether intra-aortic balloon (IABP) is the joining link between these two variables and whose presence needs in any case be considered in multivariable statistics. Post-percutaneous coronary intervention TC could be only a secondary effect of IABP use. On turn, the prolonged use of heparin necessarily accompanying the use of IABP, and producing a paradoxical pro-thrombotic TC, might also be implicated.