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Impact of immune thrombocytopenic purpura on clinical outcomes in patients with acute myocardial infarction.

ABSTRACT: BACKGROUND:Patients with immune thrombocytopenic purpura (ITP) admitted with acute myocardial infarction (AMI) may be challenging to manage given their increased risk of bleeding complications. There is limited evidence in the literature guiding appropriate interventions in this population. The objective of this study is to determine the difference in clinical outcomes in AMI patients with and without ITP. METHODS:Using the United States national inpatient sample database, adults aged ?18?years, who were hospitalized between 2007 and 2014 for AMI, were identified. Among those, patients with ITP were selected. A propensity-matched cohort analysis was performed. The primary outcome was in-hospital mortality. Secondary outcomes were coronary revascularization procedures, bleeding and cardiovascular complications, and length of stay (LOS). RESULTS:The propensity-matched cohort included 851 ITP and 851 non-ITP hospitalizations for AMI. There was no difference in mortality between ITP and non-ITP patients with AMI (6% vs7.3%, OR:0.81; 95% CI:0.55-1.19; P = .3). When compared to non-ITP patients, ITP patients with AMI underwent fewer revascularization procedures (40.9% vs 45.9%, OR:0.81; 95% CI:0.67-0.98; P = .03), but had a higher use of bare metal stents (15.4% vs 11.3%, OR:1.43; 95% CI:1.08-1.90; P = .01), increased risk of bleeding complications (OR:1.80; CI:1.36-2.38; P?

SUBMITTER: Chehab O

PROVIDER: S-EPMC6954382 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Impact of immune thrombocytopenic purpura on clinical outcomes in patients with acute myocardial infarction.

Chehab Omar O Abdallah Nadine N Kanj Amjad A Pahuja Mohit M Adegbala Oluwole O Morsi Rami Z RZ Mishra Tushar T Afonso Luis L Abidov Aiden A

Clinical cardiology 20191111 1

<h4>Background</h4>Patients with immune thrombocytopenic purpura (ITP) admitted with acute myocardial infarction (AMI) may be challenging to manage given their increased risk of bleeding complications. There is limited evidence in the literature guiding appropriate interventions in this population. The objective of this study is to determine the difference in clinical outcomes in AMI patients with and without ITP.<h4>Methods</h4>Using the United States national inpatient sample database, adults ...[more]

PMID: 31710764

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Project description:BackgroundImmune-mediated thrombotic thrombocytopenic purpura (iTTP) may lead to microvascular thrombosis and mortality, despite patients receiving appropriate standard of care treatment (immunosuppressive therapy and therapeutic plasma exchange). Caplacizumab directly inhibits von Willebrand factor-platelet interaction and consequently prevents microthrombi formation.ObjectivesThis study aimed to determine the efficacy and safety of caplacizumab in diverse, clinically relevant patient subgroups.MethodsIn this post hoc analysis of phase 3 HERCULES study (NCT02553317), patients were categorized by clinically relevant subgroups (prior iTTP history, iTTP severity at presentation, and initial immunosuppression regimen).ResultsIn patients with previous acute iTTP episodes, less severe disease at presentation, or those who received a corticosteroid-only initial immunosuppression regimen, time to platelet count response was shorter with caplacizumab vs placebo. Across all subgroups, fewer patients experienced a composite outcome of iTTP-related death, exacerbation, or major thromboembolic event on caplacizumab vs placebo. Placebo-treated patients remained at risk of exacerbations and refractoriness on either initial immunosuppression regimen (ie, corticosteroids only or corticosteroids plus rituximab). In the corticosteroids plus rituximab group, no exacerbations were reported in caplacizumab-treated patients, but 8 of the 16 (50%) patients experienced exacerbations in the placebo group. Safety outcomes were consistent with the findings of the main HERCULES study.ConclusionCaplacizumab treatment of acute iTTP, in combination with therapeutic plasma exchange and immunosuppression, was safe and effective regardless of prior iTTP history, severity, or initial immunosuppression regimen and improved patient outcomes across clinically diverse subgroups. These findings emphasize the need for treatments with rapid onset of action that can reduce mortality and iTTP-related complications.

Dataset Information

Impact of immune thrombocytopenic purpura on clinical outcomes in patients with acute myocardial infarction.

Publications

Impact of immune thrombocytopenic purpura on clinical outcomes in patients with acute myocardial infarction.

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