Severe thrombocytopenia independently predicted higher risks for major adverse cardiovascular events (HR 2.30) and bleeding (HR 2.88) in patients undergoing percutaneous coronary intervention on dual-antiplatelet therapy.
Cohort (n=368)
No
Does moderate or severe thrombocytopenia increase the risk of MACE and bleeding in patients undergoing PCI on DAPT compared to mild thrombocytopenia?
Moderate and severe thrombocytopenia are independently associated with increased risks of bleeding and cardiovascular events in patients on DAPT post-PCI.
Effect estimate: HR 2.30 (95% CI 1.89-2.81)
p-value: p=<0.001
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.
Sharma et al. (2026) conducted a cohort in Thrombocytopenia in patients undergoing percutaneous coronary intervention (PCI) (n=368). Severe thrombocytopenia vs. Mild thrombocytopenia was evaluated on Major adverse cardiovascular events (MACE) (HR 2.30, 95% CI 1.89-2.81, p=<0.001). Severe thrombocytopenia independently predicted higher risks for major adverse cardiovascular events (HR 2.30) and bleeding (HR 2.88) in patients undergoing percutaneous coronary intervention on dual-antiplatelet therapy.
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