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Background <p>Patients with thrombocytopenia undergoing percutaneous coronary intervention (PCI) are at an elevated risk of bleeding and adverse cardiovascular events due to dual-antiplatelet therapy (DAPT). Limited data exist on the safety of DAPT in this subset of patients.</p> Methods <p>This single-centre prospective cohort study was conducted at SMS Medical College, Jaipur, India, over 12 months (March 2024–March 2025). A total of 368 patients with baseline (pre-PCI) thrombocytopenia who underwent elective or emergency PCI while on DAPT were enrolled. DAPT comprised aspirin plus a P2Y12 inhibitor: clopidogrel in 317 patients (86.1%), ticagrelor in 48 (13.0%), and prasugrel in 3 (0.8%), with the choice based on clinician discretion; the distribution did not differ significantly across thrombocytopenia grades (<i>p</i> = 0.204). DAPT was generally maintained for 6–12 months per institutional protocol, without a standardized de-escalation strategy. Thrombocytopenia was classified based on pre-procedural platelet counts as mild (100,000–150,000/mm³; <i>n</i> = 237, 64.4%), moderate (50,000–100,000/mm³; <i>n</i> = 104, 28.2%), or severe (30,000–50,000/mm³; <i>n</i> = 27, 7.3%). The primary outcomes were major adverse cardiovascular events (MACE), defined as a composite of total death, myocardial infarction (MI), coronary revascularization, stroke, and hospitalization due to heart failure; and bleeding events assessed using Bleeding Academic Research Consortium (BARC) criteria. Secondary outcomes included in-hospital mortality, stent thrombosis, target vessel revascularization, and post-PCI MI. Follow-up was conducted at 1, 2, and 6 months post-PCI. Multivariate logistic regression was used to adjust for confounders across three sequential models (demographics; clinical variables; procedural outcomes).</p> Results <p>Severe thrombocytopenia independently predicted higher risks for MACE (HR: 2.30, CI: 1.89–2.81) and bleeding (HR: 2.88, CI: 2.37–3.49) across all models. Mild thrombocytopenia showed no significant risk after adjustment for confounders. Patients with moderate thrombocytopenia demonstrated consistent risks for both outcomes. Smoking and history of PCI/MI significantly correlated with thrombocytopenia severity (<i>p</i> &lt; 0.01).</p> Conclusion <p>Moderate and severe thrombocytopenia are independently associated with increased risks of bleeding and cardiovascular events in patients on DAPT post-PCI. These observational findings support the incorporation of thrombocytopenia severity into existing risk stratification frameworks; however, as this study did not evaluate alternative management strategies, prospective randomized trials are needed to determine whether modified antiplatelet regimens can improve outcomes in this high-risk population.</p>

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Impact of thrombocytopenia on bleeding and cardiovascular outcomes in patients undergoing percutaneous coronary intervention with dual-antiplatelet therapy

  • 期刊论文

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  • 发表日期：

    2026年5月11日

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  • Vishnu Sharma,
  • Rajat Pachori,
  • Vansh Bagrodia,
  • Abhinav Agarwal,
  • Arpita Digwal,
  • Yajat Raisinghani,
  • Naman Modi,
  • Vansh Gupta,
  • Toshit Vijayvergia,
  • Abhishek Jhajharia,
  • Harshvarshan Sharma,
  • Prinshu Garg,
  • Suhani Mittal

摘要

Background

Patients with thrombocytopenia undergoing percutaneous coronary intervention (PCI) are at an elevated risk of bleeding and adverse cardiovascular events due to dual-antiplatelet therapy (DAPT). Limited data exist on the safety of DAPT in this subset of patients.

Methods

This single-centre prospective cohort study was conducted at SMS Medical College, Jaipur, India, over 12 months (March 2024–March 2025). A total of 368 patients with baseline (pre-PCI) thrombocytopenia who underwent elective or emergency PCI while on DAPT were enrolled. DAPT comprised aspirin plus a P2Y12 inhibitor: clopidogrel in 317 patients (86.1%), ticagrelor in 48 (13.0%), and prasugrel in 3 (0.8%), with the choice based on clinician discretion; the distribution did not differ significantly across thrombocytopenia grades (p = 0.204). DAPT was generally maintained for 6–12 months per institutional protocol, without a standardized de-escalation strategy. Thrombocytopenia was classified based on pre-procedural platelet counts as mild (100,000–150,000/mm³; n = 237, 64.4%), moderate (50,000–100,000/mm³; n = 104, 28.2%), or severe (30,000–50,000/mm³; n = 27, 7.3%). The primary outcomes were major adverse cardiovascular events (MACE), defined as a composite of total death, myocardial infarction (MI), coronary revascularization, stroke, and hospitalization due to heart failure; and bleeding events assessed using Bleeding Academic Research Consortium (BARC) criteria. Secondary outcomes included in-hospital mortality, stent thrombosis, target vessel revascularization, and post-PCI MI. Follow-up was conducted at 1, 2, and 6 months post-PCI. Multivariate logistic regression was used to adjust for confounders across three sequential models (demographics; clinical variables; procedural outcomes).

Results

Severe thrombocytopenia independently predicted higher risks for MACE (HR: 2.30, CI: 1.89–2.81) and bleeding (HR: 2.88, CI: 2.37–3.49) across all models. Mild thrombocytopenia showed no significant risk after adjustment for confounders. Patients with moderate thrombocytopenia demonstrated consistent risks for both outcomes. Smoking and history of PCI/MI significantly correlated with thrombocytopenia severity (p < 0.01).

Conclusion

Moderate and severe thrombocytopenia are independently associated with increased risks of bleeding and cardiovascular events in patients on DAPT post-PCI. These observational findings support the incorporation of thrombocytopenia severity into existing risk stratification frameworks; however, as this study did not evaluate alternative management strategies, prospective randomized trials are needed to determine whether modified antiplatelet regimens can improve outcomes in this high-risk population.