Eptifibatide-induced acute profound thrombocytopenia: a case report

Custovic

Case Reports in Critical Care

et al. 2021

Background. Eptifibatide is a glycoprotein IIb/IIIa (GP IIb/IIIa) receptor inhibitor which prevents platelet activation. The mechanism in which eptifibatide causes profound thrombocytopenia is poorly understood. One hypothesis suggests antibody-dependent pathways which cause thrombocytopenia upon subsequent reexposure to eptifibatide. This case reports acute profound thrombocytopenia ( platelets < 20 × 10 3 / m m 3 ) within 24 hours of administration. Alveolar hemorrhage occurred during a second eptifibatide infusion 5 days after initial asymptomatic eptifibatide treatment. Case Presentation. A 50-year-old male presenting with a STEMI was treated with eptifibatide during cardiac catheterization. Twelve hours posttreatment, the patient encountered profound thrombocytopenia and hemoptysis. The patient was briefly intubated for airway protection. The patient was stabilized after receiving platelet transfusion and fully recovered. Conclusion. This is one of several cases reported on eptifibatide causing acute profound thrombocytopenia and subsequent alveolar hemorrhage. This case supports the theory in which antibodies contribute to eptifibatide-induced thrombocytopenia.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute Profound Thrombocytopenia Induced by Eptifibatide Causing Diffuse Alveolar Hemorrhage

Custovic

Case Reports in Critical Care

et al. 2021

Case Reports in Hematology

“…Immune thrombocytopenia occurring as a response to GP IIb/IIIa inhibitors is well documented in the existing literature, including multiple studies and case reports [ 40 – 49 ] and is diagnosed clinically by excluding other causes of thrombocytopenia and documenting resolution of thrombocytopenia upon drug discontinuation. This adverse effect resulting from tirofiban and other GP IIB/IIIa inhibitors is particularly concerning, considering how widely they are used in modern cardiovascular medicine practice for treatment of NSTEMIs and during percutaneous coronary interventions.…”

Section: Discussionmentioning

confidence: 99%

A Case of Hyperacute Severe Thrombocytopenia Occurring Less than 24 Hours after Intravenous Tirofiban Infusion

Meghrajani

Sabharwal

Namana

et al. 2018

Thrombocytopenia is defined as a condition where the platelet count is below the lower limit of normal (<150 G/L), and it is categorized as mild (100–149 G/L), moderate (50–99 G/L), and severe (<50 G/L). We present here a 79-year-old man who developed severe thrombocytopenia with a platelet count of 6 G/L, less than 24 hours after intravenous tirofiban infusion that was given to the patient during a percutaneous transluminal coronary angioplasty procedure with placement of 3 drug-eluting stents. The patient's baseline platelet count was 233 G/L before the procedure. Based on the timeline of events during hospitalization and laboratory evidence, it was highly likely that the patient's thrombocytopenia was the result of tirofiban-induced immune thrombocytopenia, a type of drug-induced immune thrombocytopenia (DITP) which occurs due to drug-dependent antibody-mediated platelet destruction. Anticoagulant-mediated artefactual pseudothrombocytopenia was ruled out as no platelet clumping was seen on the peripheral blood smears. The treatment of DITP includes discontinuation of the causative drug; monitoring of platelet count recovery; or treatment of severe thrombocytopenia with glucocorticoids, IVIG, or platelet transfusions depending on the clinical presentation. The most likely causative agent of this patient's thrombocytopenia—tirofiban—was discontinued, and the patient did not develop any signs of bleeding during the remainder of his hospital stay. His platelet count gradually improved to 24 G/L, and he was discharged on the sixth hospital day.

“…There are some case reports and case series that provide a range of 1 to 5 days for platelet counts to recover after EIT develops, but higher-quality studies are needed to provide a more reliable time for platelet recovery. [24][25][26] Other unknowns are whether total dosage is a factor that increases the risk of EIT and if there is a relationship between the level of thrombocytopenia and the types of bleeding a patient is predisposed to. At present, evidencebased guidelines on the management of EIT and the role of therapies, including corticosteroids and IVIG, are lacking.…”

Section: Conclusion and Relevancementioning

confidence: 99%

“…The GP IIb/IIIa receptors function by binding fibrinogen and adhesion proteins to form cross-links between platelets. 1 Eptifibatide is administered intravenously; it has immediate onset and a half-life of about 2 to 4 hours. 2,3 Although it is among one of the antiplatelet agents used in acute coronary syndrome, its rate of use has decreased in recent years.…”

Section: Introductionmentioning

confidence: 99%

Complications and Management of Eptifibatide-Induced Thrombocytopenia

et al. 2021

Background Eptifibatide is used in acute coronary syndromes to reversibly block platelet aggregation by inhibiting the platelet glycoprotein IIb/IIIa receptor. A serious adverse effect of eptifibatide is a profound drop in platelet count, termed eptifibatide-induced thrombocytopenia (EIT). Objective To provide insight into the types of complications and management of EIT. Methods Cases of EIT submitted to the Food and Drug Administration adverse event reporting system were evaluated. Data analyses included management of EIT, complications of thrombocytopenia, initial platelets, and platelet nadir following eptifibatide. Results 103 cases of EIT were reported from January 2010 to 2019; 57 cases met the Naranjo scale and were included. Only 37 of those cases contained information on how EIT was managed. Eptifibatide administration was withheld in all 37 of those cases. Platelet transfusions were administered in 20 cases (54%). Two cases were managed with steroids (5.4%), and 1 case used intravenous immunoglobulin G to reverse EIT (2%). The median initial platelet count prior to administration of eptifibatide was 207 000 cells/mm3 (SD = 69 000; n = 27), and median platelet nadir was 9000 cells/mm3 (SD = 19 000; n = 35) The majority of complications of EIT included bleeding events (16/28, 57%). Delayed procedures, prolonged stay, allergic reactions, and thrombosis were each reported in 3 patients (10.75%). Conclusion and Relevance Most cases of EIT were managed by withholding eptifibatide with platelet transfusion if necessary. The majority of complications included bleeding. However, significant procedure delays, prolonged hospital stay, thrombosis, and allergic reactions were also reported.