AUTHOR=Wilson Nathaniel R. , Lee Michelle T. , Gill Clarence D. , Serauto Canache Astrid , Donisan Teodora , Balanescu Dinu V. , Song Juhee , Palaskas Nicolas , Lopez-Mattei Juan , Cilingiroglu Mehmet , Marmagkiolis Konstantinos , Iliescu Cezar A. 

TITLE=Prognostic Factors and Overall Survival After Pericardiocentesis in Patients With Cancer and Thrombocytopenia

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=8

YEAR=2021

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2021.638943

DOI=10.3389/fcvm.2021.638943

ISSN=2297-055X

ABSTRACT=<p><bold>Background:</bold> Pericardiocentesis is an important diagnostic and therapeutic tool for cancer-associated pericardial effusion. Limited safety and outcomes data exists regarding the management of malignancy-related pericardial effusion in patients with thrombocytopenia.</p><p><bold>Objectives:</bold> Our study aimed to analyze prognostic factors and overall survival (OS) after pericardiocentesis in thrombocytopenic cancer patients.</p><p><bold>Methods and Results:</bold> A retrospective review of 136 thrombocytopenic cancer patients who underwent primary percutaneous pericardiocentesis was performed. Degree of thrombocytopenia was classified by platelet count recorded on day of pericardiocentesis: 75–149 × 10<sup>3</sup> cells/μL (41%); 50–74 × 10<sup>3</sup> cells/μL (10%); 25–49 × 10<sup>3</sup> cells/μL (24%); &lt;25 × 10<sup>3</sup> cells/μL (25%). Median OS was 2.6 months and median follow-up was 37.4 months. Kaplan-Meier survival analysis showed significant OS differences among thrombocytopenia severity groups (<italic>p</italic> = 0.023), and worse OS with platelets &lt;100 vs. ≥100 × 10<sup>3</sup> cells/μL (<italic>p</italic> = 0.031). By univariate analysis, thrombocytopenia severity was associated with increased risk of death (HR 0.993; 95% CI 0.989–0.997; <italic>p</italic> = 0.002). Poor prognostic factors for OS were advanced cancer, malignant effusion, elevated international normalized ratio (INR), quantity of platelet transfusions, and platelet transfusion resistance. However, thrombocytopenia severity became insignificant for OS (<italic>p</italic> = 0.802), after adjusting for advanced cancer and INR.</p><p><bold>Conclusions:</bold> For patients with malignancy-related large pericardial effusion and thrombocytopenia, pericardiocentesis is a feasible intervention and should be considered due to low complication rates. There is no absolute contraindication to pericardiocentesis in case of hemodynamic instability, even with severe thrombocytopenia.</p>