title: Idiopathic thrombocytopenic purpura and percutaneous coronary stenting: a dangerous duo?
abstract: Dual antiplatelet therapy is a mainstay in the management of patients undergoing coronary stenting. Whether this is also appropriate in patients with a diagnosis of idiopathic thrombocytopenic purpura (ITP) is unclear. We report the case of a 66-year-old man with ITP admitted for an acute coronary syndrome. On admission platelets were 110 x 10(9)/L without petechiae or purpura, and coronary angiography revealed multivessel disease with significant left main involvement. Given the unfeasibility of surgical revascularization with cardiopulmonary bypass because of ITP, a staged percutaneous revascularization strategy was chosen. Both left circumflex and right coronary arteries were treated with bare-metal stenting during the index admission. After 4 weeks of strict clinical monitoring and evidence of a stable total platelet count on oral prednisone, percutaneous coronary intervention with drug-eluting stenting was performed in the left main and left anterior descending arteries. He was then discharged on lifelong aspirin and a 6-month clopidogrel regimen without thrombotic or bleeding complications. Given the paucity of data on ITP and stenting, no strict recommendations can be proposed and treatment should be individualized to minimize both bleeding and thrombosis risks. Nonetheless, this case suggests the feasibility of percutaneous revascularization in selected patients with multivessel coronary disease and ITP.
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.forename: Maria
authors.initials: M
authors.lastname: Teresa Lucciola
authors.forename: Luisa
authors.initials: L
authors.lastname: Morena
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.forename: Antonio
authors.initials: A
authors.lastname: Laudito
authors.forename: Matteo
authors.initials: M
authors.lastname: Anselmino
authors.forename: Gian
authors.initials: G
authors.lastname: Paolo Trevi
authors.forename: Imad
authors.initials: I
authors.lastname: Sheiban
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000150:complications* / Q000188:drug therapy / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016553:Purpura, Thrombocytopenic, Idiopathic / Q000150:complications*; D015607:Stents
chemical_list: D010975:Platelet Aggregation Inhibitors