Contribution of Bleeding and Thromboembolic Events to In-Hospital Mortality Among Patients With Thrombocytopenia Treated With Heparin

• Published in: The American journal of cardiology Vol. 104; no. 2; pp. 292 - 297
• Main Authors: Jolicoeur, E. Marc, MD, MSc, Ohman, E. Magnus, MD, Honeycutt, Emily, MS, Becker, Richard C., MD, Crespo, Eric M., MD, MPH, Oliveira, Gustavo B.F., MD, Moliterno, David J., MD, Anstrom, Kevin J., PhD, Granger, Christopher B., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 15.07.2009; Elsevier; Elsevier Limited
• Subjects: Aged; Anticoagulants - adverse effects; Anticoagulants - therapeutic use; Biological and medical sciences; Blood and lymphatic vessels; Cardiology; Cardiology. Vascular system; Cardiovascular; Coagulation; Confidence Intervals; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Drugs; Female; Hematologic and hematopoietic diseases; Hemorrhage; Hemorrhage - chemically induced; Hemorrhage - mortality; Heparin - adverse effects; Heparin - therapeutic use; Hospital Mortality; Hospitalization; Hospitals; Humans; Incidence; Male; Medical sciences; Middle Aged; Mortality; Multivariate Analysis; Odds Ratio; Platelet diseases and coagulopathies; Registries; Risk Factors; Thrombocytopenia - complications; Thrombocytopenia - drug therapy; Thrombocytopenia - mortality; Thromboembolism - chemically induced; Thromboembolism - mortality; Human; Thrombocytopenia; Prognosis; Mortality; Cardiovascular disease; Hemopathy; Epidemiology; Hemorrhage; Thrombosis; Embolism; Vascular disease; Platelet; Treatment; Circulatory system; Heparin; Hospital; Cardiology; Thromboembolism
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2009.03.034

In a population of patients experiencing thrombocytopenia while treated with heparin, bleeding and thromboses are well-appreciated complications, but their relative contributions to mortality have been less well described. In this population, the aims of this study were (1) to identify the independent predictors of bleeding and (2) to compare the incidence and the strength of association of bleeding and of new thromboses to in-hospital mortality. The independent predictors of bleeding and in-hospital mortality were identified using multivariate logistic regression models on the 1,478 patients who developed thrombocytopenia after their enrollment in the Complications After Thrombocytopenia Caused by Heparin (CATCH) study. The independent predictors of bleeding were chronic hematologic disorders, intra-aortic balloon pump, congestive heart failure, and platelet count nadir <120 × 109 /L. Although bleeding (n = 141 [10%]) and thromboembolic complications (n = 135 [9%]) were equally prevalent, the former was less strongly associated than the latter with in-hospital mortality (odds ratio 1.75, 95% confidence interval 1.01 to 3.03, and odds ratio 2.77, 95% confidence interval 1.67 to 4.61, respectively). In conclusion, medical management should be directed mainly at the prevention of thromboembolic complications, while additionally considering the risk for bleeding.