{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T19:33:39Z","timestamp":1783971219841,"version":"3.55.0"},"reference-count":17,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"22","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[1999,6,8]]},"abstract":"<jats:p>\n            <jats:italic>Background<\/jats:italic>\n            \u2014The significance of thrombocytopenia in patients experiencing an acute coronary syndrome (ACS) has not been examined systematically. We evaluated this condition in a large non\u2013ST-elevation ACS clinical trial, with particular interest paid to its correlation with clinical outcomes.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Methods and Results<\/jats:italic>\n            \u2014Patients presenting without persistent ST elevation during an ACS were randomized to receive a double-blind infusion of the platelet glycoprotein (GP) IIb\/IIIa inhibitor eptifibatide or placebo in addition to other standard therapies including heparin and aspirin. The primary end point was death\/nonfatal myocardial infarction (MI) at 30 days, whereas bleeding and stroke were the main safety outcomes. Thrombocytopenia (nadir platelet count &lt;100\u00d710\n            <jats:sup>9<\/jats:sup>\n            \/L or &lt;50% of baseline) occurred in 7.0% of enrolled patients. The time to onset was a median of 4 days in both treatment arms. Patients with thrombocytopenia were older, weighed less, were more likely nonwhite, and had more cardiac risk factors. These patients experienced significantly more bleeding events: they were more than twice as likely to experience moderate\/severe bleeding after adjustment for confounders. Univariably, ischemic events (stroke, MI, and death) occurred significantly (\n            <jats:italic>P<\/jats:italic>\n            &lt;0.001) more frequently in patients with thrombocytopenia; multivariable regression modeling preserved this association with death\/nonfatal MI at 30 days. Neither the use of heparin or eptifibatide was found to independently increase thrombocytopenic risk.\n          <\/jats:p>\n          <jats:p>\n            <jats:italic>Conclusions<\/jats:italic>\n            \u2014Although causality between thrombocytopenia and adverse clinical events could not be established definitively, thrombocytopenia was highly correlated with both bleeding and ischemic events, and the presence of this condition identified a more-at-risk patient population.\n          <\/jats:p>","DOI":"10.1161\/01.cir.99.22.2892","type":"journal-article","created":{"date-parts":[[2012,6,12]],"date-time":"2012-06-12T00:42:29Z","timestamp":1339461749000},"page":"2892-2900","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":126,"title":["Clinical Significance of Thrombocytopenia During a Non\u2013ST-Elevation Acute Coronary Syndrome"],"prefix":"10.1161","volume":"99","author":[{"given":"Matthew W.","family":"McClure","sequence":"first","affiliation":[{"name":"From the Duke Clinical Research Institute (M.W.M., S.D.B., R.S., R.T., L.G.B., R.M.C., R.A.H.), Durham, NC; Methodist Hospital (N.S.K.), Houston, Tex; Cleveland Clinic Foundation (A.M.L., E.J.T.), Cleveland, Ohio; Cardialysis (J.D.), Rotterdam, Netherlands; Estudios Cardiologicos Latinoamerica (R.D.), Rosario, Argentina; Eberhard Karls University (K.R.K.), Tubingen, Germany; COR Therapeutics (D.G., M.K.), South San Francisco, Calif; and Thoraxcenter University Hospital (M.S.), Rotterdam, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott D.","family":"Berkowitz","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute (M.W.M., S.D.B., R.S., R.T., L.G.B., R.M.C., R.A.H.), Durham, NC; Methodist Hospital (N.S.K.), Houston, Tex; Cleveland Clinic Foundation (A.M.L., E.J.T.), Cleveland, Ohio; Cardialysis (J.D.), Rotterdam, Netherlands; Estudios Cardiologicos Latinoamerica (R.D.), Rosario, Argentina; Eberhard Karls University (K.R.K.), Tubingen, Germany; COR Therapeutics (D.G., M.K.), South San Francisco, Calif; and Thoraxcenter University Hospital (M.S.), Rotterdam, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodney","family":"Sparapani","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute (M.W.M., S.D.B., R.S., R.T., L.G.B., R.M.C., R.A.H.), Durham, NC; Methodist Hospital (N.S.K.), Houston, Tex; Cleveland Clinic Foundation (A.M.L., E.J.T.), Cleveland, Ohio; Cardialysis (J.D.), Rotterdam, Netherlands; Estudios Cardiologicos Latinoamerica (R.D.), Rosario, Argentina; Eberhard Karls University (K.R.K.), Tubingen, Germany; COR Therapeutics (D.G., M.K.), South San Francisco, Calif; and Thoraxcenter University Hospital (M.S.), Rotterdam, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Tuttle","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute (M.W.M., S.D.B., R.S., R.T., L.G.B., R.M.C., R.A.H.), Durham, NC; Methodist Hospital (N.S.K.), Houston, Tex; Cleveland Clinic Foundation (A.M.L., E.J.T.), Cleveland, Ohio; Cardialysis (J.D.), Rotterdam, Netherlands; Estudios Cardiologicos Latinoamerica (R.D.), Rosario, Argentina; Eberhard Karls University (K.R.K.), Tubingen, Germany; COR Therapeutics (D.G., M.K.), South San Francisco, Calif; and Thoraxcenter University Hospital (M.S.), Rotterdam, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neal S.","family":"Kleiman","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute (M.W.M., S.D.B., R.S., R.T., L.G.B., R.M.C., R.A.H.), Durham, NC; Methodist Hospital (N.S.K.), Houston, Tex; Cleveland Clinic Foundation (A.M.L., E.J.T.), Cleveland, Ohio; Cardialysis (J.D.), Rotterdam, Netherlands; Estudios Cardiologicos Latinoamerica (R.D.), Rosario, Argentina; Eberhard Karls University (K.R.K.), Tubingen, Germany; COR Therapeutics (D.G., M.K.), South San Francisco, Calif; and Thoraxcenter University Hospital (M.S.), Rotterdam, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa G.","family":"Berdan","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute (M.W.M., S.D.B., R.S., R.T., L.G.B., R.M.C., R.A.H.), Durham, NC; Methodist Hospital (N.S.K.), Houston, Tex; Cleveland Clinic Foundation (A.M.L., E.J.T.), Cleveland, Ohio; Cardialysis (J.D.), Rotterdam, Netherlands; Estudios Cardiologicos Latinoamerica (R.D.), Rosario, Argentina; Eberhard Karls University (K.R.K.), Tubingen, Germany; COR Therapeutics (D.G., M.K.), South San Francisco, Calif; and Thoraxcenter University Hospital (M.S.), Rotterdam, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. Michael","family":"Lincoff","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute (M.W.M., S.D.B., R.S., R.T., L.G.B., R.M.C., R.A.H.), Durham, NC; Methodist Hospital (N.S.K.), Houston, Tex; Cleveland Clinic Foundation (A.M.L., E.J.T.), Cleveland, Ohio; Cardialysis (J.D.), Rotterdam, Netherlands; Estudios Cardiologicos Latinoamerica (R.D.), Rosario, Argentina; Eberhard Karls University (K.R.K.), Tubingen, Germany; COR Therapeutics (D.G., M.K.), South San Francisco, Calif; and Thoraxcenter University Hospital (M.S.), Rotterdam, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaap","family":"Deckers","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute (M.W.M., S.D.B., R.S., R.T., L.G.B., R.M.C., R.A.H.), Durham, NC; Methodist Hospital (N.S.K.), Houston, Tex; Cleveland Clinic Foundation (A.M.L., E.J.T.), Cleveland, Ohio; Cardialysis (J.D.), Rotterdam, Netherlands; Estudios Cardiologicos Latinoamerica (R.D.), Rosario, Argentina; Eberhard Karls University (K.R.K.), Tubingen, Germany; COR Therapeutics (D.G., M.K.), South San Francisco, Calif; and Thoraxcenter University Hospital (M.S.), Rotterdam, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rafael","family":"Diaz","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute (M.W.M., S.D.B., R.S., R.T., L.G.B., R.M.C., R.A.H.), Durham, NC; Methodist Hospital (N.S.K.), Houston, Tex; Cleveland Clinic Foundation (A.M.L., E.J.T.), Cleveland, Ohio; Cardialysis (J.D.), Rotterdam, Netherlands; Estudios Cardiologicos Latinoamerica (R.D.), Rosario, Argentina; Eberhard Karls University (K.R.K.), Tubingen, Germany; COR Therapeutics (D.G., M.K.), South San Francisco, Calif; and Thoraxcenter University Hospital (M.S.), Rotterdam, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl R.","family":"Karsch","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute (M.W.M., S.D.B., R.S., R.T., L.G.B., R.M.C., R.A.H.), Durham, NC; Methodist Hospital (N.S.K.), Houston, Tex; Cleveland Clinic Foundation (A.M.L., E.J.T.), Cleveland, Ohio; Cardialysis (J.D.), Rotterdam, Netherlands; Estudios Cardiologicos Latinoamerica (R.D.), Rosario, Argentina; Eberhard Karls University (K.R.K.), Tubingen, Germany; COR Therapeutics (D.G., M.K.), South San Francisco, Calif; and Thoraxcenter University Hospital (M.S.), Rotterdam, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Gretler","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute (M.W.M., S.D.B., R.S., R.T., L.G.B., R.M.C., R.A.H.), Durham, NC; Methodist Hospital (N.S.K.), Houston, Tex; Cleveland Clinic Foundation (A.M.L., E.J.T.), Cleveland, Ohio; Cardialysis (J.D.), Rotterdam, Netherlands; Estudios Cardiologicos Latinoamerica (R.D.), Rosario, Argentina; Eberhard Karls University (K.R.K.), Tubingen, Germany; COR Therapeutics (D.G., M.K.), South San Francisco, Calif; and Thoraxcenter University Hospital (M.S.), Rotterdam, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Kitt","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute (M.W.M., S.D.B., R.S., R.T., L.G.B., R.M.C., R.A.H.), Durham, NC; Methodist Hospital (N.S.K.), Houston, Tex; Cleveland Clinic Foundation (A.M.L., E.J.T.), Cleveland, Ohio; Cardialysis (J.D.), Rotterdam, Netherlands; Estudios Cardiologicos Latinoamerica (R.D.), Rosario, Argentina; Eberhard Karls University (K.R.K.), Tubingen, Germany; COR Therapeutics (D.G., M.K.), South San Francisco, Calif; and Thoraxcenter University Hospital (M.S.), Rotterdam, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten","family":"Simoons","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute (M.W.M., S.D.B., R.S., R.T., L.G.B., R.M.C., R.A.H.), Durham, NC; Methodist Hospital (N.S.K.), Houston, Tex; Cleveland Clinic Foundation (A.M.L., E.J.T.), Cleveland, Ohio; Cardialysis (J.D.), Rotterdam, Netherlands; Estudios Cardiologicos Latinoamerica (R.D.), Rosario, Argentina; Eberhard Karls University (K.R.K.), Tubingen, Germany; COR Therapeutics (D.G., M.K.), South San Francisco, Calif; and Thoraxcenter University Hospital (M.S.), Rotterdam, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric. J.","family":"Topol","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute (M.W.M., S.D.B., R.S., R.T., L.G.B., R.M.C., R.A.H.), Durham, NC; Methodist Hospital (N.S.K.), Houston, Tex; Cleveland Clinic Foundation (A.M.L., E.J.T.), Cleveland, Ohio; Cardialysis (J.D.), Rotterdam, Netherlands; Estudios Cardiologicos Latinoamerica (R.D.), Rosario, Argentina; Eberhard Karls University (K.R.K.), Tubingen, Germany; COR Therapeutics (D.G., M.K.), South San Francisco, Calif; and Thoraxcenter University Hospital (M.S.), Rotterdam, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert M.","family":"Califf","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute (M.W.M., S.D.B., R.S., R.T., L.G.B., R.M.C., R.A.H.), Durham, NC; Methodist Hospital (N.S.K.), Houston, Tex; Cleveland Clinic Foundation (A.M.L., E.J.T.), Cleveland, Ohio; Cardialysis (J.D.), Rotterdam, Netherlands; Estudios Cardiologicos Latinoamerica (R.D.), Rosario, Argentina; Eberhard Karls University (K.R.K.), Tubingen, Germany; COR Therapeutics (D.G., M.K.), South San Francisco, Calif; and Thoraxcenter University Hospital (M.S.), Rotterdam, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Harrington","sequence":"additional","affiliation":[{"name":"From the Duke Clinical Research Institute (M.W.M., S.D.B., R.S., R.T., L.G.B., R.M.C., R.A.H.), Durham, NC; Methodist Hospital (N.S.K.), Houston, Tex; Cleveland Clinic Foundation (A.M.L., E.J.T.), Cleveland, Ohio; Cardialysis (J.D.), Rotterdam, Netherlands; Estudios Cardiologicos Latinoamerica (R.D.), Rosario, Argentina; Eberhard Karls University (K.R.K.), Tubingen, Germany; COR Therapeutics (D.G., M.K.), South San Francisco, Calif; and Thoraxcenter University Hospital (M.S.), Rotterdam, Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_1_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)07493-4"},{"key":"e_1_3_2_2_2","unstructured":"American Heart Association. 1997 Heart and Stroke Statistical Update. Dallas Tex: American Heart Association; 1997:2\u201329."},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(94)90634-3"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-115-4-256"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(98)00254-X"},{"key":"e_1_3_2_6_2","first-page":"81b","volume":"90","year":"1997","unstructured":"Berkowitz SD, Sparapani RA, Califf RM, Cohen M. Occurrence and significance of thrombocytopenia in unstable angina and non-Q-wave infarction in the ESSENCE trial. Blood. 1997;90:81b. Abstract.","journal-title":"Blood"},{"key":"e_1_3_2_7_2","first-page":"PS","volume":"236","year":"1997","unstructured":"Berkowitz SD, Granger CB, Thompson T, Kleiman NS, Topol EJ, Califf RM. Thrombocytopenia was associated with greater hemorrhage and higher mortality in GUSTO IIb trial. Thromb Haemost. 1997;236:PS-962. Abstract.","journal-title":"Thromb Haemost"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(98)81446-0"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199808133390704"},{"key":"e_1_3_2_10_2","unstructured":"Wali AU Gavrila D Sim MJ Malhotra S Palazzo AM Hochman JS. An improved regimen for heparin use in acute coronary syndromes. Circulation. 1997;96(suppl I):I-597. Abstract."},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-116-5-403"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199309023291001"},{"key":"e_1_3_2_13_2","first-page":"359A","volume":"33","year":"1999","unstructured":"Boersma E, Pieper K, Wilcox RG, Steyerberg E, Lee KL, Akkerhuis M, Harrington RA, Califf RM, Simoons ML. The risk of adverse outcome in patients with acute coronary syndromes without ST-elevation is mainly determined by baseline clinical factors. J Am Coll Cardiol. 1999;33:359A. Abstract.","journal-title":"J Am Coll Cardiol"},{"key":"e_1_3_2_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0735-1097(98)00134-X"},{"key":"e_1_3_2_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/0735-1097(88)90158-1"},{"key":"e_1_3_2_16_2","doi-asserted-by":"publisher","DOI":"10.1159\/000415157"},{"key":"e_1_3_2_17_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199505183322003"}],"container-title":["Circulation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/01.CIR.99.22.2892","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,12]],"date-time":"2024-05-12T16:47:01Z","timestamp":1715532421000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/01.CIR.99.22.2892"}},"subtitle":["The Platelet Glycoprotein IIb\/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) Trial Experience"],"short-title":[],"issued":{"date-parts":[[1999,6,8]]},"references-count":17,"journal-issue":{"issue":"22","published-print":{"date-parts":[[1999,6,8]]}},"alternative-id":["10.1161\/01.CIR.99.22.2892"],"URL":"https:\/\/doi.org\/10.1161\/01.cir.99.22.2892","relation":{},"ISSN":["0009-7322","1524-4539"],"issn-type":[{"value":"0009-7322","type":"print"},{"value":"1524-4539","type":"electronic"}],"subject":[],"published":{"date-parts":[[1999,6,8]]},"assertion":[{"value":"1998-07-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"1999-03-29","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"1999-06-08","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}