Platelet count and outcome in patients with acute venous thromboembolism

Pierpaolo Di Micco; Nuria Ruiz-Giménez; José Antonio Nieto; Drahomir Aujesky; Fátima del Molino; Reina Valle; Manuel Barrón; Ana Maestre; Manuel Monreal; the RIETE Investigators

doi:10.1160/TH13-04-0352

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2013; 110(05): 1025-1034
DOI: 10.1160/TH13-04-0352

Platelets and Blood Cells

Schattauer GmbH

Platelet count and outcome in patients with acute venous thromboembolism

Authors

Pierpaolo Di Micco

¹Department of Internal Medicine, Ospedale Buonconsiglio Fatebenefratelli, Naples, Italy
Nuria Ruiz-Giménez

²Department of Internal Medicine, Hospital La Princesa, Madrid, Spain
José Antonio Nieto

³Department of Internal Medicine, Hospital Virgen de la Luz, Cuenca, Spain
Drahomir Aujesky

⁴Department of General Internal Medicine, Bern University Hospital and University of Bern, Bern, Switzerland
Fátima del Molino

⁵Department of Internal Medicine, Hospital General de Catalunya, Barcelona, Spain
Reina Valle

⁶Department of Internal Medicine, Hospital de Sierrallana, Santander, Cantabria, Spain
Manuel Barrón

⁷Department of Pneumonology, Complejo Hospitalario San Millán y San Pedro, Logroño, La Rioja, Spain
Ana Maestre

⁸Department of Internal Medicine, Hospital Vinalopó Salud, Alicante, Spain
Manuel Monreal

⁹Department of Internal Medicine, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain

the RIETE Investigators

Abstract

Summary

The relationship between platelet count and outcome in patients with acute venous thromboembolism (VTE) has not been consistently explored. RIETE is an ongoing registry of consecutive patients with acute VTE. We categorised patients as having very low- (<80,000/μl), low- (80,000/μl to 150,000/μl), normal- (150,000/μl to 300,000/μl), high- (300,000/μl to 450,000/μl), or very high (>450,000/μl) platelet count at baseline, and compared their three-month outcome. As of October 2012, 43,078 patients had been enrolled in RIETE: 21,319 presenting with pulmonary embolism and 21,759 with deep-vein thrombosis. In all, 502 patients (1.2%) had very low-; 5,472 (13%) low-; 28,386 (66%) normal-; 7,157 (17%) high-; and 1,561 (3.6%) very high platelet count. During the three-month study period, the recurrence rate was: 2.8%, 2.2%, 1.8%, 2.1% and 2.2%, respectively; the rate of major bleeding: 5.8%, 2.6%, 1.7%, 2.3% and 4.6%, respectively; the rate of fatal bleeding: 2.0%, 0.9%, 0.3%, 0.5% and 1.2%, respectively; and the mortality rate: 29%, 11%, 6.5%, 8.8% and 14%, respectively. On multivariate analysis, patients with very low-, low-, high- or very high platelet count had an increased risk for major bleeding (odds ratio [OR]: 2.70, 95% confidence interval [CI]: 1.85–3.95; 1.43 [1.18–1.72]; 1.23 [1.03–1.47]; and 2.13 [1.65–2.75]) and fatal bleeding (OR: 3.70 [1.92–7.16], 2.10 [1.48–2.97], 1.29 [0.88–1.90] and 2.49 [1.49–4.15]) compared with those with normal count. In conclusion, we found a U-shaped relationship between platelet count and the three-month rate of major bleeding and fatal bleeding in patients with VTE.

Keywords

Platelet count - bleeding - mortality - venous thromboembolism

Full Text

References

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