901 Thrombocytopenia Risk Following Glycoprotein IIB/IIIA Inhibitor use for ST-Elevation Myocardial Infarction (STEMI)

Abstract

The role of glycoprotein IIB/IIIA Inhibitor (GPI) use during ST-elevation myocardial infarction (STEMI) is uncertain in the era of contemporary P2Y12 inhibitors. They can be helpful in selected patients but requires careful consideration of potential risks including increased thrombocytopenia and propensity to major bleeding events. We performed a multicentered, retrospective, cohort study of consecutive patients presenting with STEMI, who underwent either primary percutaneous intervention (pPCI) or thrombolysis with subsequent coronary angiogram. Select patients were administered GPI according to best practice guidelines. Platelet values were sourced from all STEMI admissions between 2014–2019 at baseline, 24 and 48 hours post angiogram. Secondary analysis examined major bleeding events up to 1 month. 420 patients were analysed with 25 administered GPI (10 Tirofiban, 15 Abciximab). At 48 hours, there was a non-significant average decrease in platelets of 45.1x109/L compared to 19.9x109/L in the pPCI group (p=0.056) and an average decrease of 66.1x109/L compared to 18.3x109/L in the thrombolysis group (p=0.59) in those that did and did not receive GPI respectively. Furthermore, there was no significant difference in major bleeding between the two groups (2.5% GPI group, 2.8% in non GPI). There was no statistically significant difference in platelet reduction with GPI use during coronary angiogram and their use did not equate to any increase in detectable major bleeding at one month. Our findings suggest that GIIB/IIIA-I use should not be limited due to bleeding concerns in the STEMI population, although the GPI population size was small.