Clinical importance of thrombocytopenia in patients with acute coronary syndromes : a systematic review and meta-analysis
Thrombocytopenia in acute coronary syndromes
Article [Accepted Manuscript]
Is part ofPlatelets
Publisher(s)Taylor & Francis
- Université de Montréal. Faculté de médecine
- Université de Montréal. Faculté de pharmacie
Thrombocytopenia (TP) is common in hospitalized patients. In the context of acute coronary syndromes (ACS), TP has been linked to adverse clinical outcomes. We present a systematic review and meta-analysis of the evidence on the clinical importance of pre-existing and in-hospital acquired TP in the context of ACS. Specifically, we address (a) the prevalence and associated factors with TP in the context of ACS; and (b) the association between TP and all-cause mortality, major adverse cardiovascular events (MACE) and major bleeding. We conducted systematic literature searches in MEDLINE and Web of Science. For the meta-analysis, we fit linear mixed models with a random study-specific intercept for the aggregate outcomes. A total of 16 studies and 190,915 patients were included in this study. Of these patients, 8.8% ± 1.2% presented with pre-existing TP while 5.8% ± 1.0% developed TP after hospital admission. Pre-existing TP was not statistically significantly associated with adverse outcomes. Acquired TP was associated with greater risk of all-cause mortality (risk difference (RD): 4.3%; 95% confidence interval (CI): 2% - 6%; p=0.04), MACE (RD: 8.5%; 95% CI: 1% -16.0%; p=0.037) and major bleeding (RD: 11.9%; 95% CI: 5% - 19%; p=0.005). In conclusion, TP is a prevalent condition in patients admitted for an ACS and identifies a high-risk patient population more likely to experience ischemic and bleeding complications, as well as higher mortality.