Intraaortic Balloon Pumps and Thrombocytopenia

1
Intra-aortic Balloon Pumps and Thrombocytopenia

• by Sion Roy MD
• with Edward Howard MD PhD, Julio Panza MD, Howard
  Cooper MD

2
Intra-aortic Balloon Pump (IABP)

• First developed at Cleveland Clinic in the 1960s
• Most common circulatory assist devices in the
  United States
• Indicated for cardiogenic shock

3
(No Transcript)
4
Thrombocytopenia

• Known effect of IABPs
• Likely secondary to the shear effect of the
  IABPs, as well as to the critical illness
  inherent with cardiogenic shock

5
Clinical Questions

• Platelet trends with IABPs?
• Impact of Heparin on thrombocytopenia?
• Major bleeding and in-hospital mortality with
  thrombocytopenia?
• Impact of length of IABP insertion on major
  bleeding?

6
Methods

• 252 patients
• Retrospective
• 182 patients received heparin
• Analyzed platelets trends in 10 days after IABP
  insertion
• Analyzed for major bleeding and in-hospital
  mortality using multivariate analysis

7
(No Transcript)
8
(No Transcript)
9
(No Transcript)
10
(No Transcript)
11
(No Transcript)
12
Impact of Heparin

• The heparin and non-heparin cohorts started with
  similar platelet counts (mean of 237100.2 and
  219.284.9 respectively).
• The use of heparin did not significantly affect
  the platelet count in patients with nadir counts
  expressed as a percent of initial platelet counts
  of 65.923.7 and 70.223.7 respectively.

13
Major Bleeding

• Increased length of IABP insertion time
  independently predicted major bleeding
  (OR1.17-1.86 p0.001), while thrombocytopenia
  did not independently predict major bleeding
  (OR0.76-6.4 p0.144)

14
In-hospital Mortality

• Thrombocytopenia did not independently predict
  in-hospital mortality (OR0.75-2.9 p0.262).

15
Conclusions

• Clinicians should remove IABPs as soon as safely
  possible to prevent major bleeding complications.
• When IABP patients become thrombocytopenic, there
  is no increased risk of major bleeding or
  in-hospital mortality.
• Heparin does not affect the amount of
  thrombocytopenia in these patients.