Incidence of Thrombocytopenia in Hospitalized Patients with Venous Thromboembolism
published online 14 August 2009.
Abstract
Purpose
To determine the incidence of heparin-associated thrombocytopenia in patients receiving prophylaxis or treatment for venous thromboembolism.
Methods
We assessed the database of the National Hospital Discharge Survey from 1979 through 2005 and complemented this with a meta-analysis of published literature.
Result
Among 10,554,000 patients discharged from short-stay hospitals throughout the US with venous thromboembolism during the 27 years of study, secondary thrombocytopenia was coded in 38,000 patients (0.36%). From 1979 through 1992, secondary thrombocytopenia was coded in only 0.15% of hospitalized patients with venous thromboembolism. The frequency increased sharply to 0.54% from 1993 through 2005. Secondary thrombocytopenia was rarely diagnosed among 1,446,000 patients aged <40 years and among 77,000 women who had venous thromboembolism with deliveries. Meta-analysis of published literature showed a higher incidence among patients who received unfractionated heparin (UFH) for prophylaxis than those who received low-molecular-weight heparin (LMWH) for prophylaxis. Treatment resulted in smaller differences of the incidence between UFH and LMWH.
Conclusion
Heparin-associated thrombocytopenia is rare among patients aged <40 years and women following delivery. The risk of heparin-associated thrombocytopenia is more duration-related than dose-related, and higher with UFH when used for an extended duration. Our findings and those of the literature suggest that although heparin-associated thrombocytopenia is uncommon, the incidence can be minimized by use of LMWH, particularly if extended prophylaxis or extended treatment is required.
aResearch and Advanced Studies Program, Michigan State University, College of Osteopathic Medicine, Detroit Medical Center Campus, Detroit, Mich
bDepartment of Medicine, University of Calgary, Alberta, Canada
cDepartment of Internal Medicine, St. Joseph Mercy Oakland Hospital, Pontiac, Mich
Requests for reprints should be addressed to Paul D. Stein, MD, 44405 Woodward Avenue, Pontiac, MI 48341-5023
Funding: None.
Conflict of Interest: Russell Hull has received research support from Sanofi-Aventis and Leo-pharma. He has been on advisory boards for Sanofi-Aventis, Boehringer Ingelheim, Bayer, and Pfizer. None of the authors have any conflict of interest with the content of this article.
Authorship: All authors had access to the data and a role in writing the manuscript.
ABSTRACT
