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.