Glycoprotein IIb/IIIa inhibitor associated severe thrombocytopenia in patients with coronary artery disease: Clinical course and outcomes

Abstract

Thrombocytopenia, both at baseline and acquired throughout admission is associated with poor clinical outcomes in patients with coronary artery disease. It is not known whether severe thrombocytopenia in patients receiving glycoprotein IIb/IIIa inhibitors (GPI) carries the same risk as thrombocytopenia from other aetiologies. We identified 50 consecutive patients referred for percutaneous coronary intervention (PCI) who developed severe thrombocytopenia (<50 × 10(9) cells/l) and followed their clinical course to 30 days. Two groups were compared: (1) severe thrombocytopenia following GPI usage and (2) severe thrombocytopenia without exposure to GPI. Baseline platelet counts were higher in GPI group (201 ± 62 vs. 112 ± 83 × 10(9) cells/l, p < 0.05). Patients in GPI group had more profound thrombocytopenia yet quicker recovery of platelet counts. The GPI group received fewer blood product transfusions (red cells: 0.1 ± 0.4 vs. 1.3 ± 2.0, p < 0.05, platelets: 0.22 ± 0.6 vs. 1.1 ± 1.7, p < 0.05) and had lower event rates for the primary end point of 30-day mortality (3.7% vs. 42.1%, p < 0.05), and for major bleeding (0% vs. 15.8%, p < 0.05). In conclusion, GPI associated severe thrombocytopenia follows a distinct clinical course when compared to severe thrombocytopenia due to other aetiologies. Our results suggest that patients who develop severe thrombocytopenia following GPI therapy may be managed conservatively with careful monitoring.

A Novel Pentapeptide Targeting Integrin β3-Subunit Inhibits Platelet Aggregation and Its Application in Rat for Thrombosis Prevention

“…Nevertheless, these patients were confronted with another risk of intrinsic bleeding, which raised the paradox of the antiplatelet substance being able to inhibit the thrombosis efficiently but not affecting the normal coagulation. Given that platelets play an essential role in hemostasis and thrombosis (Abtahian et al, 2015 ), balancing platelet function is effective in preventing thrombosis and seems to be the key to reducing bleeding risk during antiplatelet therapy (Viswanathan et al, 2012 ). In fact, because of the high risk of bleeding due to their unconscionable high affinity to αIIbβ3, receptor inhibitors are no longer considered clinically safe (Elcioglu et al, 2012 ).…”

Treatment tactics for acute coronary syndrome in primary immune thrombocytopenia

“…Результаты исследования показали, что у пациентов 1 группы отмечалась более выраженная ТЦП, но нормализация количества тромбоцитов происходила в более короткие сроки. В 1 группе отмечалась более низкая 30-дневная летальность (3,7 % против 42,1 %, р<0,05) и не было тяжелых кровотечений (0 % против 15,8 %, р<0,05) [49].…”

Is There Still a Role for Glycoprotein IIb/IIIa Antagonists in Acute Coronary Syndromes?

“…Thrombocytopenia and major bleeding are the more frequent complications associated with this class of drugs [26, 27]. Security and efficacy of these agents have been widely demonstrated and it should be considered that GP inhibitor induced thrombocytopenia is less related to increased risk of clinical complications than thrombocytopenia secondary to other causes (for example hematological, drug induced, septical or in relation to low output states) [26, 27].…”