A 64-year-old man suffering from ST-elevation myocardial infarction and severe thrombocytopenia: Procedures in the case of a patient not fitting the guidelines

Abstract

The objective of this case report is to present how the chronic condition significantly complicates life-saving procedures and influences further treatment decisions. A 64-year-old man suffering from arterial hypertension and immune thrombocytopenic purpura presented to the Emergency Department with anterior ST-elevation myocardial infarction. An immediate coronary angiography was performed where critical stenosis of the proximal left anterior descending was found. It was followed by primary percutaneous intervention with bare metal stent. In first laboratory results, extremely low platelet count was found (13 × 10 9 /L). Consulting haematologist advised the use of single antiplatelet therapy and from the second day of hospitalisation only clopidogrel was prescribed. On the sixth day of hospital stay, patient presented acute chest pain with ST elevation in anterior leads. Emergency coronary angiography confirmed acute stent thrombosis and aspiration thrombectomy was performed. It was therefore agreed to continue dual antiplatelet therapy for 4 weeks. As there are no clinical trials where patients with low platelet count are included, all therapeutic decisions must be made based on clinician’s experience and experts’ consensus. Both the risk of haemorrhagic complications and increased risk of thrombosis must be taken into consideration when deciding on patient’s treatment.

Treatment tactics for acute coronary syndrome in primary immune thrombocytopenia

“…Эти пациенты, склонные к повышенной кровоточивости, оказались не защищены от развития тромботических процессов. Впервые на это было обращено внимание при анализе 205 взрослых больных ПИТ, среди которых у 5 % были зарегистрированы тромботические или ишемические события [2]. Оказалось, что больные с ПИТ не только не застрахованы от развития тромботических осложнений, но имеют повышенный риск развития ОКС, венозных тромбозов, ТЭЛА, ишемических инсультов.…”