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Background: Percutaneous peripheral arterial intervention (PPAI) patients are at a high risk of developing heparin-induced thrombocytopenia due to the need for repeated and prolonged heparin exposure. We sought to investigate the incidence, outcomes, and economic impact of heparin-induced thrombocytopenia post-PPAI utilizing the National Inpatient Sample. Methods: All patients who underwent PPAI (age ≥18 years) from 2007 to 2014 were identified by using ICD-9-CM codes. Patients were then classified into two groups based on the presence or absence of heparin-induced thrombocytopenia during hospitalization. In-hospital outcomes were compared between the two groups after propensity-score matching to account for differences in baseline characteristics. Results: Heparin-induced thrombocytopenia was reported in 527 patients (0.23%). After adjusting for patient-level and hospital-level characteristics, in-hospital mortality differences were not significantly different between patients with heparin-induced thrombocytopenia vs. those without heparin-induced thrombocytopenia (odds ratio (OR) 1.02, 95% confidence interval (CI) 0.67 to 1.57, p = 0.951). However, PPAI patients with heparin-induced thrombocytopenia were more likely to develop ischemic stroke (OR 3.84, 95%CI 1.26 to 11.75, p = 0.018), deep venous thrombosis/pulmonary embolism (OR 1.32, 95%CI 0.79 to 1.79, p = 0.078), and acute kidney injury requiring dialysis (OR 4.04, 95%CI 1.72 to 9.50, p = 0.001). Furthermore, post-PPAI patients who developed heparin-induced thrombocytopenia had longer hospitalizations (13.8 vs. 9.8 days, p < 0.0001), higher cost of stay ($62,022 vs. $44,904, p < 0.0001), and higher rates of non-routine home discharges (50.15% vs. 42.19%, p = 0.013). Conclusion: Among patients who underwent PPAI, heparin-induced thrombocytopenia was associated with a higher risk of venous thrombosis/pulmonary embolism, ischemic stroke, acute kidney injury requiring dialysis, prolonged hospital stay, and increased cost. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Direct oral anticoagulants can potentially provide a more convenient oral alternative for the management of left ventricular thrombi than Warfarin. These medications do not require frequent monitoring and have less drug‐drug interactions. Randomized controlled trials are needed to further demonstrate their efficacy and safety in this setting. Direct oral anticoagulants can potentially provide a more convenient oral alternative for the management of left ventricular thrombi than Warfarin. These medications do not require frequent monitoring and have less drug‐drug interactions. Randomized controlled trials are needed to further demonstrate their efficacy and safety in this setting. [ABSTRACT FROM AUTHOR]

Background: Evidence suggests that the ischemic etiology of heart failure (HF) is a predictor of mortality in patients receiving guidline directed medical therapy as well as in patients undergoing heart transplantation. Little is known about the impact of the ischemic etiology of HF in patients undergoing left ventricular assist device (LVAD) placement. Therefore, we investigated this underexplored gap in knowledge. Methods: The National Inpatient Sample Database was queried from 2009-2014 to identify all hospitalizations in patients aged ≥18 years with the LVAD placement. The primary outcome was in-hospital all-cause mortality. The differences in outcomes between ischemic (ICM) and non-ischemic cardiomyopathy (NICM) in LVAD placement were examined using complex samples multivariable logistic or generalized linear model regressions. Results: The study population included 3,511patients that underwent LVAD placement from 2009 to 2014. Of these, 1,880 (53.5 %) had ICM, while 1631 (46.5 %) had NICM. Patients in the ICM group were older and had a higher prevalence of several major comorbidities. Patients with ICM were found to have a significantly higher risk of hemorrhage requiring transfusion (OR1.29, 95% CI 1.08 to 1.53), vascular complications requiring surgery (OR 1.58 95% CI 1.10 to 2.28) and postoperative ST-segment myocardial infarction (OR 7.38 95% CI 5.33 to 10.24). There was no difference between ICM and NICM cohorts with regards to in-hospital mortality, ischemic stroke, acute kidney injury, postoperative sepsis, respiratory complications, hemopericardium, cardiac tamponade or hemolytic anemia. Conclusion: We found that ischemic etiology of heart failure did not impact in-hospital mortality in patients undergoing LVAD placement but was a predictor of perioperative complications including bleeding requiring transfusion, vascular complications, and postoperative myocardial infarction. [ABSTRACT FROM AUTHOR]

Introduction: Heparin-Induced thrombocytopenia (HIT) is a known mortality predictor amongst patients undergoing cardiac surgery. Little is known about the impact of HIT on in-hospital outcomes of patients undergoing percutaneous coronary intervention (PCI). We, therefore, investigated this, hypothesizing that HIT may increase in-hospital mortality and postprocedural complications. Methods: Patients who underwent PCI with or without HIT between 2008 and 2015 were identified in the National Inpatient Sample (NIS) database using the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9CM). We compared outcomes among patients who had HIT and those who did not using a propensity score analysis to account for differences in baseline characteristics. The primary outcome was all-cause in-hospital mortality. Secondary outcomes were postprocedural complications. Results: Of 891,084 hospitalizations for PCI from 2008 to 2015, 33% were female and the mean age was 64.5 years ± 12.45. 846 (0.10%) patients had HIT. Patients with HIT were found to have a significantly higher rate of postoperative deep vein thrombosis and pulmonary embolism (DVT/PE) (OR 3.85, 95% CI 2.48 to 5.99), Acute kidney injury (AKI) (OR 1.38, 95% CI 1.11 to 1.70) and AKI requiring dialysis (OR 2.43 95% CI 1.54 to 3.84). Patients with HIT also had longer a length of hospital stay (OR 1.36 95% CI 1.24 to 1.50) and a higher cost of hospitalization (OR 1.45 95% CI 1.31 to 1.60). No difference in mortality was found between the HIT and the no-HIT cohorts. Conclusions: HIT was rare amongst patients undergoing PCI, and was not associated with in-hospital mortality. It was however associated with postprocedural complications, increased length of stay and cost of hospitalization. [ABSTRACT FROM AUTHOR]