[Acute profound thrombocytopenia associated with tirofiban: clinical approach to diagnosis and therapeutic management].
Acute profound thrombocytopenia is a serious complication of glycoprotein IIb/IIIa inhibitor therapy characterized by a precipitous decline in platelet count to <20 x 10(9)/l within few hours of therapy initiation. This potentially devastating event is extremely uncommon in patients receiving small molecule inhibitors such as eptifibatide and tirofiban. The authors present a case of a patient with acute coronary syndrome scheduled for urgent percutaneous coronary intervention who developed acute profound thrombocytopenia during treatment with intravenous tirofiban. The platelet count decreased to a nadir of 3 x 10(9)/l 2 h after initiation of inhibitor administration. All other possible etiologies of thrombocytopenia were unlikely and the low platelet count had to be attributed to tirofiban. Tirofiban was discontinued and the patient was treated with steroids, immunoglobulin and platelet transfusion. No bleeding events occurred and the patient was discharged on day 18. Interestingly, the patient underwent a percutaneous coronary intervention 1 month before and received the same dosage regimen of tirofiban without complications. Implications for the incidence, diagnosis and treatment of thrombocytopenia disorders are discussed.
Agnelli
Davide
D
Unità di Terapia Intensiva Coronarica, Dipartimento di Cardiologia, Ospedale Sacra Famiglia Fatebenefratelli, Erba. davideagnelli@interfree.it
Ottani
Filippo
F
D000208:Acute Disease; D000368:Aged; D005260:Female; D006801:Humans; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D000077466:Tirofiban; D014443:Tyrosine / Q000009:adverse effects / Q000031:analogs & derivatives*
D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; D000077466:Tirofiban