Cardiomyopathy in Cancer Patients with Chronic Thrombocytopenia: To Cath or not to Cath?

Abstract

Background The systemic inflammatory and hypercoagulable states, as well as the cardiotoxic effects of chemo-radiation therapies, expose cancer patients to a wide spectrum of cardiovascular comorbidities that may require cardiac catheterization. The presence of thrombocytopenia increases the risk for significant bleeding during endovascular procedures. We sought to evaluate the clinical characteristics and outcomes of cancer patients with chronic thrombocytopenia undergoing cardiac catheterization for evaluation of cardiomyopathy. Methods We performed a retrospective study of patients with preprocedural thrombocytopenia undergoing cardiac catheterization indicated for cardiomyopathy (chemotherapy-induced, myopericarditis, Takotsubo, or other cardiomyopathies) between November 2009 and November 2015 at our institution. Preprocedural platelet counts were classified into 3 groups: mild thrombocytopenia (>50 K/µL), moderate thrombocytopenia (30-50 K/µL), and severe thrombocytopenia ( Results Out of a total of 148 patients that underwent coronary angiography, 50 (33.8%) had cardiomyopathy as the indication (Table). Mean platelet count on admission was 44.1 ± 29.2 K/µL. Severe thrombocytopenia was identified in 22 patients (44%), moderate thrombocytopenia in 7 patients (14%), and mild thrombocytopenia in 21 patients (42%). No periprocedural bleeding or major adverse cardiovascular events were noted. Median overall survival (OS) was 6.9 months. Patients who had congestive heart failure had significantly decreased OS (p = 0.01). Decreased hemoglobin (p = 0.08), moderate thrombocytopenia (p = 0.03), severe thrombocytopenia (p = 0.09), and LVEF Conclusions Thrombocytopenia should not represent an absolute contraindication for cardiac catheterization in cancer patients with cardiomyopathy and can be considered when hemodynamic data or information obtained invasively may impact clinical care.