Subject(s)
Aorta/diagnostic imaging , Aortic Aneurysm/diagnostic imaging , Foramen Ovale, Patent/diagnostic imaging , Postoperative Complications/diagnostic imaging , Stroke/diagnostic imaging , Thrombosis/diagnostic imaging , Aged , Aorta/surgery , Aortic Aneurysm/surgery , Foramen Ovale, Patent/complications , Heart Diseases/diagnostic imaging , Heart Diseases/etiology , Humans , Male , Postoperative Complications/etiology , Stroke/etiology , Thrombosis/etiology , Time FactorsSubject(s)
Mediastinal Neoplasms/diagnostic imaging , Pericardium/pathology , Thymoma/diagnostic imaging , Thymus Neoplasms/diagnostic imaging , Aged, 80 and over , Echocardiography, Transesophageal , Female , Humans , Mediastinal Neoplasms/surgery , Neoplasm Invasiveness , Thymoma/pathology , Thymus Neoplasms/pathologySubject(s)
Aneurysm/physiopathology , Chest Pain/etiology , Exercise Tolerance , Pulmonary Artery/physiopathology , Pulmonary Valve/physiopathology , Vascular Diseases/physiopathology , Adult , Aneurysm/diagnostic imaging , Aneurysm/surgery , Athletes , Echocardiography, Transesophageal , Humans , Male , Pulmonary Artery/diagnostic imaging , Pulmonary Artery/surgery , Pulmonary Valve/diagnostic imaging , Pulmonary Valve/surgery , Vascular Diseases/complications , Vascular Diseases/diagnostic imagingABSTRACT
INTRODUCTION: Eptifibatide 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 PRESENTATION: A 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. CONCLUSIONS: The 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.