Adverse prognostic significance of thrombocytopenia in acute coronary syndrome: can anything be done about it?

In this issue of Circulation, Wang and colleagues1 demonstrate that even mild thrombocytopenia (platelet count nadir 150 10/L) developing in patients with acute coronary syndrome (ACS) is associated with bleeding and death. Similar observations have been made in other settings. Critically ill patients with thrombocytopenia have increased duration of mechanical ventilation and risk of death.2 An increased risk of death also has been reported in thrombocytopenic patients (platelet count nadir 100 10/L) with non–ST-segment elevation ACS (odds ratio [OR], 6.7; 95% confidence interval [CI], 1.9 to 25; P 0.003).3 Patients receiving heparin in diverse clinical settings who develop thrombocytopenia also have an increased risk of death (OR, 3.4; 95% CI, 2.1 to 5.6; P 0.001); the risk is highest in patients with the greatest decrease in platelet count.4