Case Series Hemostatic Balance and Prognostic Role of Baseline Thrombocytopenia in Acute Coronary Syndrome
by Spadaro Dario1, Scremin Lorenzo1, Freddi Giulia1, Vai Federico1, Di Sabatino Antonio1,2, Melazzini Federica1,2,*
1Department of Internal Medicine and Medical Therapeutics, University of Pavia, Pavia, Italy
2Department of Internal Medicine and Medical Therapeutics, IRCCS San Matteo
*Corresponding author: Melazzini Federica, Clinica Medica I, Fondazione IRCCS Policlinico San Matteo, Università di Pavia, Viale Golgi 19, 27100 Pavia, Italy.
Received Date: 16 July, 2025
Accepted Date: 24 July, 2025
Published Date: 28 July, 2025
Citation: Dario S, Lorenzo S, Giulia F, Federico V, Antonio DS, et al. (2025) Hemostatic Balance and Prognostic Role of Baseline Thrombocytopenia in Acute Coronary Syndrome. Curr Trends Intern Med 9: 246. https://doi.org/10.29011/2638-003X.100246
Abstract
Thrombocytopenia, defined as a platelet count (PLT) below 150 x 10^9/L, is often associated with both hemorrhagic and thrombotic complications in patients with acute coronary syndrome (ACS). This review explores the prognostic implications of baseline thrombocytopenia in ACS patients, analyzing its association with mortality, major adverse cardiovascular events (MACE), and bleeding risks. While thrombocytopenia traditionally addresses an elevated risk of bleeding, it also poses thrombotic concerns, particularly in conditions such as immune thrombocytopenia (ITP) or after performing a PCI with stent placement. The literature suggests that thrombocytopenia is not only a bleeding risk marker but also an indicator of clinical complexity, contributing to heightened thrombotic and ischemic risks. Studies reviewed indicate higher incidences of bleeding, mortality, and MACE in thrombocytopenic patients compared to non-thrombocytopenic patients. Despite conflicting data on the optimal antiplatelet therapy duration in these patients, short-term dual antiplatelet therapy (DAPT) followed by careful modulation appears beneficial. More specific guidelines are necessary to better manage thrombocytopenic ACS patients, especially in terms of balancing bleeding and thrombotic risks. The findings underscore the need for individualized therapeutic approaches based on the severity and etiology of thrombocytopenia.
Keywords: Thrombocytopenia, Acute Coronary Syndrome, Major Adverse Cardiovascular Events, Bleeding Risk, Immune Thrombocytopenia.
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