Effect Of Thrombocytopenia After IABP On The Early Prognosis Of Patients With Acute Myocardial Infarction

Background:Acute myocardial infarction(AMI)is an acute and critical condition in cardiovascular medicine,and percutaneous coronary intervention(PCI)is its main treatment,AMI patients are often associated with hemodynamic instability,and in addition to the use of vasoactive Aortic balloon counterpulsation(IABP)is a commonly used mechanical circulatory support device,and despite its controversial effectiveness,it is still widely used in clinical practice because of its own advantages.Thrombocytopenia is a common postoperative complication of IABP with a high incidence;it is also controversial whether the occurrence of thrombocytopenia after IABP in patients with acute myocardial infarction affects their early prognosis.We want to investigate the incidence of thrombocytopenia,the pattern of platelet changes,and the impact on early prognosis in patients with acute myocardial infarction who were supported by IABP as mechanical circulation due to hemodynamic instability before PCI,and to find the risk factors for thrombocytopenia after IABP.Methods:Patients admitted to the First Affiliated Hospital of Nanchang University from2017.1.1 to 2022.12.31 for pre-PCI due to hemodynamic instability using IABP as mechanical circulatory support were screened to investigate the incidence of thrombocytopenia,the pattern of platelet changes,and the impact on their early prognosis in patients with IABP as mechanical circulatory support;outcome indicators included length of stay,coronary heart disease The outcome indicators include length of stay in hospital,length of stay in the intensive care unit,morbidity and mortality rate during hospitalization,and occurrence of bleeding events.We also tried to find the risk factors of thrombocytopenia after IABP,such as antiplatelet aggregation drugs,anticoagulation regimens,and antibiotic use,to find out whether the use of these drugs after IABP would increase the risk of thrombocytopenia.Results:A total of 93 study subjects were included in this study.Among the 93 study subjects,thrombocytopenia occurred in 30 cases,and the incidence of platelets after IABP was 32.26%,with more than 50% reduction in baseline platelet count count occurring on postoperative day 5.10 ± 1.90,and the lowest platelet count was reached on postoperative day 5.72 ± 1.85.Most of the patients showed a tendency to rebound in platelet count after removal of IABP catheter.In our study,the length of stay in the Coronary Heart Disease Care Unit(CCU)and in-hospital morbidity and mortality were higher in the thrombocytopenic group than in the non-thrombocytopenic group(P<0.05),yielding a poorer prognosis in the thrombocytopenic group relative to the non-thrombocytopenic group.We tried to find the independent predictors of thrombocytopenia after IABP,and by binary logistic regression analysis,we found that thrombocytopenia was more likely to occur when the duration of IABP support was too long(P<0.05),and the duration of IABP support was an independent predictor of thrombocytopenia.Conclusion:The prognosis was worse in the thrombocytopenic group,which we believe is not directly due to thrombocytopenia,because the platelet count levels in the thrombocytopenic group were not at very low levels.In critically ill patients,thrombocytopenia is more of a red flag,alerting clinicians to the relatively poor prognosis of patients who develop thrombocytopenia;thrombocytopenia after IABP is the result of multiple factors,and mechanical depletion caused by IABP insertion should be considered first.When patients develop thrombocytopenia after IABP,early recognition,close monitoring of blood routine,appropriate differential diagnosis,early intervention and treatment should be carried out.The occurrence of pharmacogenic thrombocytopenia,such as unreasonable use of antibiotics and antipyretic and analgesic drugs,should also be avoided as much as possible.