Eptifibatide-induced thrombocytopenia: with thrombosis and disseminated intravascular coagulation immediately after left main coronary artery percutaneous coronary angioplasty.

Early clinical trials of eptifibatide did not show a significant association between eptifibatide and the development of thrombocytopenia, thrombosis, or disseminated intravascular coagulation. However, more recent literature has suggested a significant association between eptifibatide and the development of thrombocytopenia and thrombosis. Although the true incidence and the pathophysiology of these associations are unknown, the development of these events can be life-threatening. Herein, we describe the case of a patient who experienced acute onset of profound thrombocytopenia, developing thrombosis, pulmonary emboli, and disseminated intravascular coagulation. This paper adds to the few previous reports of cases that suggested an association between thrombocytopenia, thrombosis, and the administration of eptifibatide. To the best of our knowledge, this is the first case report in the medical literature that associates the new onset of thrombocytopenia, thrombosis, and disseminated intravascular coagulation with the administration of eptifibatide. We also provide a subject review.

Tirofiban-induced diffuse alveolar hemorrhage: after primary angioplasty.

Platelets play an important role in the development of acute coronary syndromes. Evidence indicates that platelet-inhibiting drugs, such as glycoprotein IIb/IIIa inhibitors, can be beneficial when they are administered at the time of primary percutaneous coronary intervention for acute ST-segment-elevation myocardial infarction. However, an associated increase in the risk of bleeding is well documented. Diffuse alveolar hemorrhage is a rare but life-threatening and underdiagnosed complication of therapy with glycoprotein IIb/IIIa inhibitors. Diffuse alveolar hemorrhage can easily be mistaken for acute pulmonary edema, a condition commonly seen in patients with acute coronary syndrome. Physicians need to be aware of this diagnostic dilemma, because early treatment increases the chance that the patients will survive.Herein, we report the fatal outcome of diffuse alveolar hemorrhage in a 73-year-old man who presented with acute ST-segment-elevation myocardial infarction and was treated with tirofiban in conjunction with primary percutaneous coronary intervention. In addition, we review the medical literature pertaining to the sequelae of glycoprotein IIb/IIIa inhibitor therapy in the presence of diffuse alveolar hemorrhage.

Left main stent thrombosis complicated by eptifibatide-induced acute thrombocytopenia.

A 57-year-old man with a history of coronary artery disease and placement of an implantable cardioverter-defibrillator presented at our emergency room with an anterior ST-elevation myocardial infarction. Cardiac catheterization revealed an acutely occluded left main coronary artery, which was revascularized successfully with a bare-metal stent. Periprocedurally, the patient received aspirin, clopidogrel, unfractionated heparin, and eptifibatide. The patient was discharged a week later, but he returned to the emergency room the same day with recurrence of severe chest pain. Repeat cardiac catheterization revealed an acutely occluded stent, and the patient underwent repeat bare-metal stent placement and readministration of eptifibatide. On the next day, the patient's platelet count dropped acutely to less than 12,000/mm3. A test for heparin-induced thrombocytopenia antibody was negative. After discontinuation of eptifibatide, the patient's platelet count gradually returned to normal, and he was later discharged from the hospital with no complications. Eptifibatide-induced acute thrombocytopenia is a known but rare adverse effect. We review the handful of case reports in the medical literature, with emphasis on the prevalence, observed clinical course, and recently proposed physiologic mechanisms that probably are responsible for this phenomenon.