Abstract:
Glycoprotein (GP) IIb/IIIa are now being widely used in patients with
acute coronary syndrome (ACS) undergoing percutaneous coronary
intervention (PCI) as they have shown to decrease mortality and
morbidity in these patients. With the growing use of these medications,
there is an increase in adverse events related to them being reported in
the literature, including severe thrombocytopenia. Here, we report a
case of a 66-year-old male patient who presented to our hospital with
signs and symptoms of heart failure, who then underwent coronary
angiography (CAG), which showed two vessel disease, with subsequent PCI
and stenting, he was then started on eptifibatide and developed
thrombocytopenia, which improved rapidly after discontinuation of the
drug.
Case :
Mr. M is a 66 year old male patient, who has a known history of Diabetes
mellitus (DM) type 2, on oral hypoglycemic agents, hypertension (HTN)
and chronic kidney disease (CKD), he presented to a periphery hospital
complaining of shortness of breath of 20 days duration, it was related
to exertion and improved with rest. In the emergency department, his
electrocardiogram (ECG) was normal and he had normal troponins, and
echocardiogram was done which showed severely reduced ejection fraction
of 13%, he was then transferred to our facility for coronary artery
disease assessment, for which a CAG was scheduled for him. He was kept
on his regular home medications and started on unfractionated heparin
5000 units twice a day for venous thrombo-embolism prophylaxis. CAG was
done and showed two vessel disease, with distal right coronary artery
(RCA) and distal left circumflex artery (LCx) showing 99% stenosis, he
was started on aspirin and clopidogrel. At this time, no intervention
was done, and the patient was planned for staged PCI for both vessels as
he had CKD. Three days later, the patient underwent PCI to RCA with 3
drug-eluting stents and was started on eptifibatide 1
microgram/kilogram/minute for a total of 18 hours after the procedure.
Patient was transferred to our high dependency unit and was improving
with no active complains. The next day, Complete blood count (CBC) was
sent for him and showed a steep decline in his platelets count, dropping
from 254 x10^3/uL to 98 x10^3/uL in less than 24 hours. Peripheral
smear and manual counting of the platelets were done to rule our
Pseudo-thrombocytopenia, which confirmed the previous readings. Heparin
induced thrombocytopenia (HIT) assays were sent and came back negative.
The patient had no evidence of bleeding. Repeat CBC over the next few
days showed rapid improvement of the platelets count, reaching back to
normal levels after 4 days from stopping Eptifibatide. Another
intervention to the LCx vessel was not done as the interventional
cardiologist reviewed the images again and decided that the patient is
only for medical management for the remaining lesion. Patients’ symptoms
improved and he was discharged soon after.