Thrombocytopenia and Coronary Artery Disease, the Existing Dilemmas

Author:

Davarashvili Ilia1,Hasin Tal1,Asher Elad1

Affiliation:

1. Jesselson Integrated Heart Center, Shaare Zedek Medical Center , Jerusalem , Israel Hebrew University Medical School

Abstract

Abstract Background: Platelets play a pivotal role in the pathogenesis of acute coronary syndrome (ACS) and acute or chronic complications following percutaneous coronary intervention (PCI) as well. Platelet inhibition is a cornerstone treatment in the management of these patients. Thrombocytopenia in patients with ACS is uncommon. Idiopathic thrombocytopenic purpura (ITP) is a rare phenomenon; nevertheless, some case series presenting concomitant ACS and ITP have been described in the literature. The safety of antiplatelet therapy and PCI in patients who have ACS and thrombocytopenia is limited. Case summary: We present a case of a 60-year-old patient with ITP who was admitted with unstable angina pectoris. On admission, the platelet count was 23 × 109/L. Coronary CT angiography revealed severe stenosis in the mid portion of RCA. After one-week treatment with high-dose Prednisolone, the platelet count recovered, and coronary catheterization was performed. Successful PCI to the RCA with drug-eluting stent was performed. The patient was discharged on dual antiplatelet therapy. Conclusion: The case suggests that PCI is a suitable treatment for ITP patients with ACS. Hemostasis is the major concern in managing these patients. The treatment strategy may be based on platelet function rather than platelet count alone. Further analysis of antiplatelet therapies as mono or dual therapy are needed.

Publisher

Walter de Gruyter GmbH

Subject

Automotive Engineering

Reference21 articles.

1. 1. Levine GN, Bates ER, Bittl JA, et al. 2016 ACC/AHA guideline focused update on duration of dual antiplatelet therapy in patients with coronary artery disease: A report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines: An update of the 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention, 2011 ACCF/AHA guideline for coronary artery bypass graft surgery, 2012 ACC/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease, 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction, 2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes, and 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery. Circulation. 2016;134:e123-e155. doi: 10.1161/CIR.0000000000000404.10.1161/CIR.0000000000000404

2. 2. Ibanez B, James S, Agewall S, et al. ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation, the task force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). Eur Heart J. 2018;39:119-177. doi: 10.1093/eurheartj/ehx393.10.1093/eurheartj/ehx393

3. 3. Bhatt DL, Hulot JS, Moliterno DJ, Harrington RA. Antiplatelet and anticoagulation therapy for acute coronary syndromes. Circ Res. 2014;114:1929-1943. doi: 10.1161/CIRCRESAHA.114.302737.10.1161/CIRCRESAHA.114.302737

4. 4. Udell JA, Bonaca MP, Collet JP, et al. Long-term dual antiplatelet therapy for secondary prevention of cardiovascular events in the subgroup of patients with previous myocardial infarction: A collaborative meta-analysis of randomized trials. Eur Heart J. 2016;37:390-399. doi: 10.1093/eurheartj/ehv443.10.1093/eurheartj/ehv443

5. 5. McClure MW, Berkowitz SD, Sparapani R, et al. Clinical significance of thrombocytopenia during a non-ST-elevation acute coronary syndrome. The platelet glycoprotein IIb/IIIa in unstable angina: Receptor suppression using integrilin therapy (PURSUIT) trial experience. Circulation. 1999;99:2892-2900. doi: 10.1161/01.cir.99.22.2892.10.1161/01.cir.99.22.2892

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