Eptifibatide-associated acute, profound thrombocytopenia.
OBJECTIVE
To describe 3 cases of eptifibatide-associated acute, profound thrombocytopenia.


METHODS
A 40-year-old black female received eptifibatide 180-microg/kg double bolus followed by a continuous infusion of 2 microg/kg/min for percutaneous coronary intervention (PCI). The platelet count decreased from 308 x 10(3)/mm3 to 2 x10(3)/mm3 4 hours after initiation of eptifibatide. Eptifibatide was discontinued and platelets were transfused. The patient developed a hematoma and petechiae. A 67-year-old white female received the same dosage regimen of eptifibatide for PCI with no serious adverse effects, with the treatment repeated one month later. At that time, she developed chest and back pain, dyspnea, wheezing, and hypotension after the first bolus. Her platelet count decreased from 334 x10(3)/mm3 to 6 x10(3)/mm3 24 hours after initiation. Eptifibatide was discontinued and platelets were transfused. The patient died due to shock. A 72-year-old white male received eptifibatide 180-microg/kg double bolus followed by a continuous infusion of 2 microg/kg/min for acute coronary syndrome. His platelet count decreased from 189 x10(3)/mm3 to 17 x10(3)/mm3, and eptifibatide was discontinued. Eptifibatide was readministered with bivalirudin for PCI once the platelet count increased to 94 x10(3)/mm3. Sixteen hours later, the platelet count decreased to 1 x 10(3)/mm3. Eptifibatide was discontinued and platelets were transfused. The patient developed a hematoma.


CONCLUSIONS
Acute, profound thrombocytopenia is a rare complication of glycoprotein IIb/IIIa inhibitor therapy characterized by a precipitous decline in platelet count to <20 x10(3)/mm3 within 24 hours of therapy. An objective causality assessment revealed that the adverse drug event was probable in 2 cases and possible in the other.


CONCLUSIONS
Increasing use of the glycoprotein IIb/IIIa inhibitors and enhanced recognition of the potential for acute, profound thrombocytopenia reinforce the need for more vigilant monitoring and alternative management strategies.
Coons
James C
JC
Cardiology, Department of Pharmacy, Allegheny General Hospital, Pittsburgh, PA 15212-4772, USA. jccst25@hotmail.com
Barcelona
Robert A
RA
Freedy
Tucker
T
Hagerty
Michael F
MF
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000077542:Eptifibatide; D005260:Female; D006801:Humans; D008297:Male; D010455:Peptides / Q000009:adverse effects*; D010976:Platelet Count; D013921:Thrombocytopenia / Q000097:blood* / Q000139:chemically induced*
D010455:Peptides; D000077542:Eptifibatide