Primäre PCI wegen akuten Myokardinfarkts bei einem Patienten mit idiopathischer thrombozytopenischer Purpura. Fallbericht und Literaturübersicht

Abstract

Considering the high bleeding risk in patients with ITP and AMI, careful balance between usual anticoagulation and antiplatelet therapy on the one hand, and efforts to raise platelet count on the other hand are needed.

Risk of Thromboembolism in Patients with Immune Thrombocytopenia

“…In ITP patients with acute coronary syndromes, Neskovic et al recommended percutaneous coronary intervention (PCI) by using bare-metal stent placement [93]. Coated coronary stents should not be used because they require more intensive anticoagulation [85].…”

“…Coated coronary stents should not be used because they require more intensive anticoagulation [85]. UFH (70-100 IU/kg) or fondaparinux (2.5 mg) + half dose UFH during PCI and acetylsalicylic acid (ASA) (300 mg) plus clopidogrel (300-600 mg) after stent placement is recommended [93].…”

Recurrent Acute Myocardial Infarction in Patients with Immune Thrombocytopenic Purpura

“…In addition, fondaparinux, unlike UFH and low molecular weight heparin, has no effect on platelet function and may thus decrease the risk of serious bleeding in thrombocytopenic patients. 20 The addition of UFH to fondaparinux is recommended due to an increased risk of catheter thrombosis that has been reported when using fondaparinux alone during PCI.…”

Challenge of Using Antiplatelet Drugs in Patients with Primary Immune Thrombocytopenia and Recently Implanted Coronary Stents-Splenectomy as a Therapeutic Option

“…Acute myocardial infarction (AMI) is very infrequent in patients with primary immune thrombocytopenia (ITP) and poses serious management problem in which a good balance between prevention of thrombosis and haemorrhagic risk must be achieved [1][2][3][4]. The main objectives in these patients are correction of thrombocytopenia and continuous administration of antiplatelet drugs.…”

“…There are only a few reports of AMI in ITP patients treated by primary percutaneous coronary intervention (PCI) and dual antiplatelet therapy. Pretreatment with some of the modalities (corticosteroids, intravenous immunoglobulins (IVIg), agonists of thrombopoietin receptors, danazol and platelet transfusions) was required in a number of those patients [1][2][3][4].…”