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Gustavo B. F. Oliveira, MD; Eric M. Crespo, MD; Richard C. Becker, MD; Emily F. Honeycutt, MBI; Charles S. Abrams, MD; Kevin J. Anstrom, PhD; Peter B. Berger, MD; Linda D. Davidson-Ray, MA; Eric L. Eisenstein, DBA; Neal S. Kleiman, MD; David J. Moliterno, MD; Stephan Moll, MD; Lawrence Rice, MD; Jo E. Rodgers, PharmD; Steven R. Steinhubl, MD; Victor F. Tapson, MD; E. Magnus Ohman, MD; Christopher B. Granger, MD; for the Complications After Thrombocytopenia Caused by Heparin (CATCH) Registry Investigators

Arch Intern Med. 2008;168(1):94-102.

Background  Despite widespread heparin use in clinical practice, the associated development of thrombocytopenia is an underrecognized and undertreated complication.

Methods  We analyzed data from consecutive hospitalized patients treated with heparin (unfractionated or low molecular weight) for 4 days or longer to determine the incidence, predictors, prognostic significance, and management of "thrombocytopenia," defined as a platelet count less than 150 x 10⁹/L, reduction in platelet count of 50% or more from the admission level, or both.

Results  We enrolled 2420 patients (median age, 65.2 years; 43.8% women) in 48 US hospitals. Thrombocytopenia occurred in 881 patients (36.4%; 95% confidence interval [CI], 34.5%-38.3%). Of those who developed thrombocytopenia, 5.1% died, compared with 1.6% of those without thrombocytopenia (odds ratio [OR], 3.4; 95% CI, 2.1-5.6; P < .001). Thrombocytopenia was also associated with greater risk of myocardial infarction (OR, 2.1; 95% CI, 1.5-2.8; P < .001) and congestive heart failure (OR, 1.3; 95% CI, 1.1-1.6; P = .01). After adjustment for important covariates, thrombocytopenia remained an independent predictor of thrombotic and hemorrhagic events. A relative reduction in platelet count of more than 70% was the strongest independent predictor of death (OR, 13.4; 95% CI, 6.5-27.6; P < .001), followed by a relative reduction in platelet count of 50% to 70%, worse Killip class, occurrence of thromboembolic complications, older age, and longer duration of heparin therapy.

Conclusions  Thrombocytopenia occurs frequently after prolonged heparin therapy and is strongly associated with worse short-term clinical outcome. The relative reduction in platelet count is a powerful independent predictor of all-cause mortality in hospitalized patients.

Author Affiliations: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina (Drs Oliveira, Becker, Anstrom, Berger, Eisenstein, Tapson, Ohman, and Granger and Mss Honeycutt and Davidson-Ray), and Department of Medicine and School of Pharmacy, University of North Carolina at Chapel Hill (Drs Crespo, Moll, Rodgers, and Ohman); Geisinger Health System, Danville, Pennsylvania (Dr Berger), and Department of Medicine, Pennsylvania School of Medicine, Philadelphia (Dr Abrams); Baylor College of Medicine, Houston, Texas (Drs Kleiman and Rice); and Department of Medicine, University of Kentucky, Lexington (Drs Moliterno and Steinhubl).