title: Eptifibatide-induced thrombocytopenia leading to acute stent thrombosis.
abstract: A 71-year old female patient with inferior ST-elevation myocardial infarction underwent primary percutaneous coronary intervention (PCI) within 3 h of symptom onset. She was preloaded with 300 mg aspirin and 600 mg clopidogrel before PCI. Coronary angiogram showed occlusion of the right coronary artery. During PCI, eptifibatide was initiated due to the large thrombus burden. Few hours after the procedure, on eptifibatide infusion, a severe drop in platelet count was observed (from 210,000/μl to 35,000/μl) and the infusion was discontinued. One hour later, still under eptifibatide effect and with severe thrombocytopenia, acute stent thrombosis developed. Lack of prior heparin exposure, quick onset of thrombocytopenia made heparin induced thrombocytopenia improbable that was later excluded by specific immunoassay. However, platelet function testing suggested that eptifibatide induced thrombocytopenia was mediated by activating autoantibodies since platelet reactivity was paradoxically very high at the time of stent thrombosis but decreased radically with eptifibatide washout. The patient was successfully managed without further complications on the basis of platelet function data obtained in the subsequent days. This rare subtype of thrombocytopenia highlights that not only platelet count but also platelet function should be closely monitored in case of severe thrombocytopenia to better balance bleeding and thrombosis.
authors: Invasive Cardiology Unit, Heart Center Balatonfüred, 2 Gyogy Sq., Balatonfüred, 8230, Hungary. dome.dezsi@gmail.com.
authors: Döme A
authors: DA
authors: Dézsi
authors: Invasive Cardiology Unit, Heart Center Balatonfüred, 2 Gyogy Sq., Balatonfüred, 8230, Hungary.
authors: György
authors: G
authors: Bokori
authors: Invasive Cardiology Unit, Heart Center Balatonfüred, 2 Gyogy Sq., Balatonfüred, 8230, Hungary.
authors: József
authors: J
authors: Faluközy
authors: Invasive Cardiology Unit, Heart Center Balatonfüred, 2 Gyogy Sq., Balatonfüred, 8230, Hungary.
authors: Csaba
authors: C
authors: Bujáky
authors: Invasive Cardiology Unit, Heart Center Balatonfüred, 2 Gyogy Sq., Balatonfüred, 8230, Hungary.
authors: György
authors: G
authors: Fogarassy
authors: Invasive Cardiology Unit, Heart Center Balatonfüred, 2 Gyogy Sq., Balatonfüred, 8230, Hungary.
authors: Gábor
authors: G
authors: Veress
authors: Invasive Cardiology Unit, Heart Center Balatonfüred, 2 Gyogy Sq., Balatonfüred, 8230, Hungary.
authors: Dániel
authors: D
authors: Aradi
mesh_terms: D000208:Acute Disease; D000368:Aged; D000077542:Eptifibatide; D006801:Humans; D010455:Peptides / Q000008:administration & dosage / Q000009:adverse effects*; D015607:Stents / Q000009:adverse effects*; D013921:Thrombocytopenia / Q000139:chemically induced*; D013927:Thrombosis / Q000139:chemically induced*
chemical_list: D010455:Peptides; D000077542:Eptifibatide
keywords: Eptifibatide; Multiplate; Stent thrombosis; Thrombocytopenia