Hematological Malignancies with Thrombocytopenia Undergoing Primary Percutaneous Pericardiocentesis: Periprocedural (30-Day) Overall Survival Analysis

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Journal of the American College of Cardiology


Background: Thrombocytopenia (TCP) is a common finding in cancer patients and traditionally has been considered a relative contraindication to pericardiocentesis (PC). This study analyzed the prognostic factors and overall survival of PC in TCP patients with diagnosis of hematologic malignancy. Methods: A retrospective search was performed in a tertiary center in all patients with hematologic malignancies with platelet (PLT) counts less 150,000/µ;L who underwent PC between 10-1-2009 to 11-30-2018. TCP grading was determined prior PC with the following thresholds: grade 1 (100-149 x 103 cells/µ;L), grade 2 (50-99 x 103 cells/µ;L), grade 3 (20-49 x 103 cells/µ;L) and grade 4 (less 20 x 103 cells/µ;L). Advanced cancer was defined as the presence of metastasis, relapsed and/or refractory disease or history of stem cell transplant. PLT resistance was defined as fail to increase PLT count by at least 10 x 103 cells/µ;L after PLT transfusion. Results: In total, 94 patients met inclusion criteria; 53.1% with advanced cancer, 18% had PLT resistance, 21.1% had pre-procedure PLT count less 20 x 103 cells/µ;L, and 4.8% underwent apical approach. Majority of patients were grade 3 group, 38.3% and grade 4 with 26.6%, with only 19.1% and 16% in 1 and 2 groups. The overall survival at 30 days was 71.2% and statistically not significant between groups. Kaplan-Meier survival analysis showed differences for survival between patients with/without diagnosis of advanced cancer (p=0.0001). Other variables associated with poor prognosis were: malignant pericardial effusion (p=0.002), PLT resistance (p=0.023) and PLT count less 20 x 103 cells/µ;L (p=0.003). Cox Regression analysis showed that diagnosis of advanced cancer significantly affects survival (HR 28.7, 95% CI 1.4-563.9). Survival was not affected by the presence of tamponade (p=0.522), pre-procedure PLT transfusion (p=0.164), apical vs subxiphoid approach (p=0.628). Conclusion: PC is a feasible intervention in patients with hematologic malignancies. Diagnosis of advanced cancer, PLT refractoriness, grade 4 TCP and presence of malignant cells in the pericardial fluid appear to affect survival within 30 days post procedure.




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