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Harris V. K. Naina, MD; Samar Harris, MD

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In their prospective study on thrombocytopenia caused by heparin, Oliveira et al¹ reported an unusually high incidence of thrombocytopenia associated with heparin use. From their trial, it is unclear whether the investigators have ruled out pseudothrombocytopenia in their patient population. Pseudothrombocytopenia is often mistaken for thrombocytopenia. A study performed on patients referred to a hematology center for thrombocytopenia showed that more than 15% had EDTA-dependent pseudothrombocytopenia.² In the study by Oliveira et al,¹ the 2 most common indications for treatment with heparin were venous thromboembolism prophylaxis (69.8%) and acute coronary syndrome(13.4%). Glycoprotein IIb/IIIa inhibitors and bivalirudin (a direct thrombin inhibitor) are widely used in percutaneous interventions. These drugs are known to cause mild to profound thrombocytopenia during percutaneous intervention. The incidence of thrombocytopenia ranged from 0.5% to 10% in various trials.^3-4 Patients who develop thrombocytopenia with either glycoprotein IIb/IIIa inhibitors or bivalirudin . . . [Full Text of this Article]

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