Abstract Number: LPB0001
Meeting: ISTH 2021 Congress
Background: Heparin induced thrombocytopenia (HIT) can be a life-threatening complication in patients with acute myocardial infarction (AMI) who receive heparin products. Impact of HIT on morbidity and mortality in AMI patients is not well studied.
Aims: We sought to determine the impact of HIT on outcomes of and treatment strategies for patients admitted with AMI.
Methods: Data was extracted from the National Inpatient Sample (NIS) 2016 – 2018 Database. The NIS was searched for hospitalizations for adult patients with AMI as principal discharge diagnosis with and without HIT as secondary diagnosis using ICD-10 codes. The primary outcome was inpatient mortality. Secondary outcomes are shown in table 1. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. Data was analyzed using STATA.
Results: A total of 1,960,949 patients were admitted for AMI, of which 2560 (0.13%) developed HIT. Mean age of patients with HIT was 67.7 years with 37.7% females. Whereas, mean age of patients without HIT was 66.9 years, with 37.9% of them being females. The adjusted odds ratio (aOR) for inpatient mortality for AMI with HIT compared to those without HIT was 1.68 (95% CI 1.226 – 2.303, p=0.001). Patients with co-morbid HIT had 10 days higher mean difference in length of stay (95% CI: 8.9 – 11.2, p<0.001) and $238,831 higher mean difference in hospital charges (95% CI: 189,781 – 287,881, p<0.001) compared to the patients without HIT. AMI patients with HIT were more likely to get coronary artery bypass graft (aOR: 6.05, 95% CI: 5.00 – 7.31, p<0.001) and less likely to have percutaneous coronary intervention (aOR: 0.48, 95% CI: 0.39 – 0.60, p<0.001) compared to their counterparts. Detailed outcomes are listed in table 1.
|Outcome||Without HIT, %||With HIT, %||aOR (95% CI)||p-value*|
|In hospital mortality||4.6||13.7||1.68 (1.226 – 2.303)||0.001*|
|Length of stay
(8.921 – 11.217) #
|Total hospital charges
(189,781 – 287,881) #
|Percutaneous coronary intervention||47.9||28.5||0.48 (0.392 – 0.604)||<0.001*|
|Coronary artery bypass graft||8.7||37.9||6.05 (5.000 – 7.312)||<0.001*|
|Intra-operative and postoperative complications of circulatory system||2.3||9.0||3.16 (2.289 – 4.354)||<0.001*|
|Post-procedural cardiogenic shock||0.2||2.2||5.61 (2.999 – 10.502)||<0.001*|
|Cardiac arrest||2.9||8.0||1.67 (1.175 – 2.383)||0.004*|
|Cardiogenic shock||6.2||28.1||3.55 (2.796 – 4.504)||<0.001*|
|IABP placement||4.0||19.7||4.29 (3.328 – 5.536)||<0.001*|
|Abbreviations: *; statistically significant, #; adjusted mean difference, aOR: adjusted odds ratio, CI: confidence interval, IABP: Intra-aortic balloon pump
Adjusting factors: age, sex, race, charlson comorbidity index, hospital location and teaching status, hospital bed size, hospital region, dyslipidemia, hypertension, obesity, chronic kidney disease, liver disease, smoking, presence of pacemaker, chronic obstructive pulmonary disease, cerebral infarction and peripheral vascular disease.
Conclusions: Development of HIT in patients with AMI is associated with increased mortality, hospital stay, hospital charges, periprocedural complications, cardiac arrest and cardiogenic shock.
To cite this abstract in AMA style:Almani MU, Tariq MJ, Usman M, Qudrat Ullah M, Yousuf M, Fatima N, Edigin E, Vij A, Gomez Valencia J. Impact of Heparin Induced Thrombocytopenia on the Outcomes of Hospitalizations for Acute Myocardial Infarction: Analysis of National Inpatient Sample [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/impact-of-heparin-induced-thrombocytopenia-on-the-outcomes-of-hospitalizations-for-acute-myocardial-infarction-analysis-of-national-inpatient-sample/. Accessed September 16, 2021.
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