Association of eptifibatide and acute profound thrombocytopenia

Hongo, Richard; Brent, Bruce N.

doi:10.1016/s0002-9149(01)01695-2

Cited by 39 publications

(31 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…GP IIb/IIIa inhibitors (e.g., eptifibatide, abciximab) improve outcome in patients undergoing percutaneous coronary intervention for acute coronary syndrome (2, 3). Thrombocytopenia is a complication of GP IIb/IIIa inhibitors, but severe thrombocytopenia (< 20 K/uL) is unusual (0.2% to 1%) (2, 4, 5). Most reported cases of severe thrombocytopenia after eptifibatide occurred in patients with acute coronary syndrome.…”

Section: Introductionmentioning

confidence: 99%

Acute Severe Thrombocytopenia Occurring After Administration of Eptifibatide Postpones Emergent Coronary Artery Surgery

2016

View full text Add to dashboard Cite

IntroductionEptifibatide is a platelet glycoprotein IIb/IIIa (GP IIb/IIIa) receptor antagonist that inhibits fibrinogen binding to the activated GP IIb/IIIa site and prevents platelet-platelet interaction and clot formation. GP IIb/IIIa inhibitors improve outcome in patients undergoing percutaneous coronary intervention for acute coronary syndrome. Thrombocytopenia is a complication of GP IIb/IIIa inhibitors, but severe thrombocytopenia is unusual. Most reported cases of severe thrombocytopenia after eptifibatide occurred in patients with acute coronary syndrome. The authors describe a patient who developed acute profound thrombocytopenia after receiving eptifibatide before emergent coronary artery bypass graft surgery.Case PresentationA 67-year-old man with a normal platelet count (220 K/uL) developed atrial fibrillation, left bundle branch block, and respiratory insufficiency consistent with acute coronary syndrome two days after colectomy. He received eptifibatide during cardiac catheterization, where three-vessel coronary artery disease was encountered. Emergent coronary artery surgery was planned, but the platelet count before surgery was 2 K/uL. Eptifibatide was discontinued, surgery was postponed, and acute coronary syndrome was treated with intraaortic balloon counterpulsation.ConclusionsThe authors describe the second reported case of eptifibatide-induced severe thrombocytopenia associated with cardiac surgery. In this case, discontinuation of eptifibatide and transfusion of apheresis platelets increased the platelet count (137 K/uL) the following day, and the patient subsequently underwent successful coronary artery surgery using cardiopulmonary bypass.

show abstract

Section: Introductionmentioning

confidence: 99%

Acute Severe Thrombocytopenia Occurring After Administration of Eptifibatide Postpones Emergent Coronary Artery Surgery

2016

View full text Add to dashboard Cite

show abstract

“…Despite their clinical efficacy, administration of all parenteral fibrinogen receptor antagonists, including eptifibatide, has been shown to increase the incidence of clinically significant thrombocytopenia (9,10,(12)(13)(14)(15)(16)(17). Though ligands that bind αIIbβ3 are capable of directly inducing both integrin and platelet activation (18)(19)(20)(21)(22), the acute thrombocytopenia that is infrequently observed after administration of eptifibatide is thought to be most commonly caused by the binding of either preexisting or neoantigeninduced drug-dependent antibodies (ddAbs) that bind to the αIIbβ3 complex in the presence of the drug (23).…”

Section: Introductionmentioning

confidence: 99%

Eptifibatide-induced thrombocytopenia and thrombosis in humans require FcγRIIa and the integrin β3 cytoplasmic domain

Gao¹,

Boylan²,

Bougie³

et al. 2009

J. Clin. Invest.

View full text Add to dashboard Cite

Thrombocytopenia and thrombosis following treatment with the integrin αIIbβ3 antagonist eptifibatide are rare complications caused by patient antibodies specific for ligand-occupied αIIbβ3. Whether such antibodies induce platelet clearance by simple opsonization, by inducing mild platelet activation, or both is poorly understood. To gain insight into the mechanism by which eptifibatide-dependent antibodies initiate platelet clearance, we incubated normal human platelets with patient serum containing an αIIbβ3-specific, eptifibatide-dependent antibody. We observed that in the presence of eptifibatide, patient IgG induced platelet secretion and aggregation as well as tyrosine phosphorylation of the integrin β3 cytoplasmic domain, the platelet FcγRIIa Fc receptor, the protein-tyrosine kinase Syk, and phospholipase Cγ2. Each activation event was inhibited by preincubation of the platelets with Fab fragments of the FcγRIIa-specific mAb IV.3 or with the Src family kinase inhibitor PP2. Patient serum plus eptifibatide did not, however, activate platelets from a patient with a variant form of Glanzmann thrombasthenia that expressed normal levels of FcγRIIa and the αIIbβ3 complex but lacked most of the β3 cytoplasmic domain. Taken together, these data suggest a novel mechanism whereby eptifibatide-dependent antibodies engage the integrin β3 subunit such that FcγRIIa and its downstream signaling components become activated, resulting in thrombocytopenia and a predisposition to thrombosis.

show abstract

“…10 Similar rates of thrombocytopenia have been observed with eptifibatide. 3,11 In general, patients with thrombocytopenia are older, weigh less, have a lower baseline platelet count, and are treated with bolus and infusion. 3,4 To extend the benefits of the acute therapy to long-term care, a number of oral GP IIb/IIIa antagonists have undergone clinical trials.…”

Section: Introductionmentioning

confidence: 99%

Evidence that thrombocytopenia observed in humans treated with orally bioavailable glycoprotein IIb/IIIa antagonists is immune mediated

Billheimer¹,

Dicker²,

Wynn³

et al. 2002

Blood

View full text Add to dashboard Cite

show abstract

Association of eptifibatide and acute profound thrombocytopenia

Cited by 39 publications

References 18 publications

Acute Severe Thrombocytopenia Occurring After Administration of Eptifibatide Postpones Emergent Coronary Artery Surgery

Acute Severe Thrombocytopenia Occurring After Administration of Eptifibatide Postpones Emergent Coronary Artery Surgery

Eptifibatide-induced thrombocytopenia and thrombosis in humans require FcγRIIa and the integrin β3 cytoplasmic domain

Evidence that thrombocytopenia observed in humans treated with orally bioavailable glycoprotein IIb/IIIa antagonists is immune mediated

Contact Info

Product

Resources

About