Incidence and Timing of Thrombocytopenia in Patients Receiving Impella Ventricular Assist Device Support

Impella devices are used in patients with cardiogenic shock or during high-risk percutaneous coronary intervention. Although thrombocytopenia is a known complication in patients receiving Impella support, the incidence and timing of thrombocytopenia remain unknown in this patient population. We retrospectively reviewed adult patients with a left-sided Impella device inserted for more than 24 hours between February 2016 and December 2019. A total of 349 patients were reviewed, and 99 patients were included. Baseline characteristics were similar between patients with thrombocytopenia and those without thrombocytopenia with the exception of median duration of Impella support, which was longer in patients with thrombocytopenia (3.7 vs. 2.1 days; p < 0.001). Thrombocytopenia occurred in 70 patients (70.7%) after Impella implantation. Median time to onset of thrombocytopenia after Impella placement was 2 days with platelet nadirs occurring after 4 days. Thrombocytopenia was mild in our study with 73% of patients having platelet nadirs above 50,000/mL. Duration of Impella support (odds ratio [OR] per day: 1.31; 95% confidence interval [CI]: 1.06-1.56; p = 0.017) and aspirin use (OR: 9.7; 95% CI: 1.46-64.5; p = 0.019) were independent predictors of thrombocytopenia. Thrombocytopenia is common in patients after Impella implantation but is not associated with adverse outcomes.