%0 Journal Article
%T Acute Serious Thrombocytopenia Associated with Intracoronary Tirofiban Use for Primary Angioplasty
%A Mustafa Yurtda£¿
%A Yalin Tolga Yaylali
%A Nesim Alada£¿
%A Mahmut £¿zdemir
%A Memi£¿ Hilmi Atay
%J Case Reports in Medicine
%D 2014
%I Hindawi Publishing Corporation
%R 10.1155/2014/190149
%X Tirofiban, a specific glycoprotein IIb/IIIa inhibitor, may cause extensive thrombocytopenia with an incidence of 0.2% to 0.5%. We report the case of a 50-year-old man who developed thrombocytopenia after tirofiban use (both intracoronary and peripheral) over hours and the successful management of this complication after primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction. 1. Introduction Glycoprotein IIb/IIIa inhibitors (GPIs) are commonly employed in treating patients who have unstable angina, non-ST, and ST-segment elevation myocardial infarction (STEMI), as well as in combination with angioplasty with or without stent placement [1]. Tirofiban, a specific and nonpeptide GPI, competitively inhibits the platelet fibrinogen receptor and may lead to severe thrombocytopenia with an incidence of 0.2% to 0.5% [2]. In this report, we describe a case of acute serious thrombocytopenia after 4£¿h of tirofiban administration in a patient in whom primary percutaneous coronary intervention (PCI) was performed for acute anterior STEMI. 2. Case Report A 50-year-old man presented with an acute anterior STEMI. Initial laboratory tests showed a normal complete blood count (CBC) including platelet count (265 109/L) at the emergency department. He reports no history of bleeding disorders, hematologic and renal problems, or heparin exposure. He immediately underwent PCI after pretreatment with 300£¿mg of aspirin and 600£¿mg of clopidogrel and 10.000£¿IU of intravenous unfractionated heparin. Coronary angiography showed the totally occluded left anterior descending artery (LAD). After predilatation, a large and fresh thrombus was seen. We first administered tirofiban via intracoronary route at a dose of 10£¿¦Ìg/kg followed by peripheral intravenous infusion at 0.15£¿¦Ìg/kg/min and then implanted a coronary 4.5 18£¿mm bare metal stent into LAD. A combination therapy of aspirin, clopidogrel, enoxaparin, and tirofiban infusion was given to the patient. Approximately 4£¿h after the PCI, areas of petechiae and ecchymoses were observed around the sternum and on both legs. The patient's platelet count was detected to be 5 109/L (Table 1). Checkup on the peripheral smear of a blood sample validated the extensive lack of platelets with no clustering. All antiplatelet drugs including tirofiban were immediately discontinued, and the patient was treated with Ig G infusion in order to achieve a quick recovery. There was a very slight rise on day 1, with improvement beginning after day 2 and counts surpassing 100 109/L on day 4 (Table 1). During this
%U http://www.hindawi.com/journals/crim/2014/190149/