Tirofiban-Induced Thrombocytopenia Occurring with Crohn’s Disease

Abstract

A 69-year-old man, with severe refractory Crohn's disease, presented with acute coronary syndrome that required angioplasty. He developed severe tirofiban-induced thrombocytopenia (TIT) heralded by type I allergic reaction that required steroids and a combination of antihistamine H1 and antihistamine H2 for symptomatic management. The thrombocytopenia spontaneously resolved uneventfully in 48 hours thereafter. This case report suggests a possible association between TIT and inflammatory bowel disease. Therefore, strict monitoring of the platelet count is required in patients who develop allergic reactions to tirofiban.

Severe Acute Thrombocytopenia After Treatment with Tirofiban: A Case Series Approach

“…1,2 The vast majority of the cases reported using recommended doses between 0.1-0.15 µg/kg/min of tirofiban, mentioning mild-to-severe clinical manifestation of bleeding, from mild events, such as gingivorrhagia, petechiae and ecchymosis, up to serious events, such as bleeding from the upper digestive tract, as reported by to haematemesis, showing that the clinical manifestations of thrombocytopenia can have a wide spectrum. [8][9][10] Others recommend the use of GPI in ACS when the patient is allergic or cannot tolerate P2Y 12 inhibitors or in patients who are undergoing PCI that have received P2Y 12 inhibitors but at higher risk for thrombus formation and in those who are allergic to aspirin. 11 In the general setting, most of the cases with platelet counts <20 × 10 3 /mm 3 on admission may be due to bone marrow failure, severe coagulopathy or immune-mediated platelet consumption, but it is important to remember that thrombocytopenia is a possible complication of treatment with GPI during PCI.…”

Rapid-Onset Thrombocytopenia Following Tirofiban Administration

“…Glycoprotein IIb/IIIa inhibitors can cause drug induced thrombocytopenia, and previous case reports have been published [6][7][8][9][10]. Platelet counts less than 100 × 10^9/L occurred in 1.1 to 1.9% of patients in clinical trials of tirofiban, and counts less than 50 × 10^9/L occurred in 0.2% to 0.5% of patients [11].…”