ASSOCIATION OF THROMBOCYTOPENIA WITH THE USE OF INTRAAORTIC BALLOON PUMPS

PURPOSE: The intra-aortic balloon pump has become an important tool in the management of patients with severe coronary artery disease. Altho ugh pump-induced thrombocytopenia was described more than 20 years ago , there has been no prospective study of this condition. PATIENTS AND METHODS: In a prospective study of consecutive adult intensive care pa tients admitted with acute coronary syndromes, we compared serial plat elet counts in 58 patients treated with an intra-aortic balloon pump w ith 51 patients who were not. All patients received intravenous hepari n. RESULTS: Clinical characteristics of the two groups were similar, e xcept that unstable angina was more frequent among balloon pump patien ts. On each of 6 consecutive days, the mean platelet counts of patient s treated with a balloon pump were significantly lower than those of n on-pump patients. Platelet counts (mean +/- SD) of balloon pump patien ts decreased to a nadir of 63% +/- 4% of the initial count on day 4, b ut subsequently stabilized. There was only a slight, transient decreas e in the platelet counts of non-pump patients. Overall, 47% of balloon pump patients developed thrombocytopenia (platelet count < 150,000/mm (3)) compared with 12% of non-pump patients (P <0.01). Platelet counts dropped by at least half of initial counts in 26% of balloon pump pat ients compared with 4% of nog-pump patients (P <0.01). Multivariate an alysis demonstrated that the use of an intra-aortic balloon pump was i ndependently associated with a substantial (greater than or equal to 5 0%) decline in platelet count (odds ratio 7.2, 95% confidence interval 1.4 to 40, P = 0.03). Removal of the balloon pump was associated with a rapid increase in platelet count. CONCLUSIONS: The use of an intra- aortic balloon pump led to a steady and predictable decrease in platel et count, which recovered rapidly if the balloon pump was removed or s lowly if the device remained in place. (C) 1998 by:Excerpta Medica, In c.