Erin Houry, PharmD,
PGY2 Critical Care Pharmacy Resident
SSM Health Saint Louis University Hospital
Saint Louis, MO
Disclosure information not submitted.
Brooke Gengler, PharmD, BCCP
Pharmacy Clinical Specialist, Cardiology
SSM Health Saint Louis University Hospital, United States
Disclosure information not submitted.
Justin Alberts
2022 PharmD Candidate
UHSP in St. Louis, United States
Disclosure information not submitted.
Joseph Van Tuyl, PharmD, BCCP, BCPS
Associate Professor, Pharmacy Clinical Specialist, Cardiology
UHSP in St. Louis, SSM Health Saint Louis University Hospital, United States
Disclosure information not submitted.
Title: Evaluation of Thrombocytopenia in Patients Receiving Circulatory Support with an Impella® Device
Introduction/Hypothesis: Thrombocytopenia and hemolysis are common complications of percutaneous mechanical circulatory support (pMCS) devices. Data regarding thrombocytopenia and hemolysis with Impella® devices is deficient compared to data available for other types of circulatory support devices. Limited understanding of the timing of thrombocytopenia may lead to inappropriate management of antithrombotic therapy. The purpose of this study was to evaluate the time course of thrombocytopenia and markers of hemolysis in patients with Impella® devices at a large hospital system.
Methods: This was a retrospective, multicenter review of electronic medical records at a large hospital system. Patients 18-89 years of age admitted from April 2018 through August 2020 who received ≥24 hours of Impella® support were included. Exclusion criteria included use of other pMCS devices, history of HIT, and presence of an Impella® device upon transfer from a hospital outside of the hospital system. The primary outcome was a descriptive analysis of thrombocytopenia incidence, onset, nadir, and duration. Signs of hemolysis, incidence of HIT, incidence of bleeding and thrombotic events, and proportion of time at goal anti-Xa levels were also collected. Predictors of thrombocytopenia were identified. This study was approved by the Saint Louis University, SSM Health St. Louis, and UHSP in St. Louis Institutional Review Boards.
Results: Ninety-three patients were included in the analysis. Thrombocytopenia occurred in 86% of patients and was evident 24 hours post-Impella® placement. The platelet nadir was 99,000/μL and occurred 84 hours post-Impella® placement. Platelet recovery occurred 116.5 hours after Impella® removal. Platelets returned to baseline 140.5 hours after Impella® removal. The total duration of thrombocytopenia was 156 hours. Signs of hemolysis were present in 44.1% of patients, were evident 12-24 hours post-Impella® placement, and resolved after Impella® removal. No patients developed HIT. No predictors of thrombocytopenia were identified by logistic regression.
Conclusions: Thrombocytopenia occurred in the majority of patients and was evident 24 hours post-Impella® placement. The time course of thrombocytopenia mirrored that of hemolysis and was not associated with any other factors.