Eptifibatide-induced acute profound thrombocytopenia in a patient with left main artery plaque rupture complicated by cardiogenic shock and gastrointestinal bleeding

Abstract

Eptifibatide inhibits platelet aggregation by reversibly binding to the platelet receptor glycoprotein (GP) IIb/IIIa of human platelets, thus preventing the binding of fibrinogen and adhesion proteins such as fibronectin, vitronectin, and von Willebrand factor to form cross bridges with adjacent platelets. There are two other GP IIb/IIIa inhibitors, namely abciximab and tirofiban, available for clinical use. Profound thrombocytopenia is an uncommon but clinically important complication of GP IIb/IIIa inhibitors. This case discusses a 64-year-old male patient who developed profound thrombocytopenia within 4 h of first administration of eptifibatide. This report adds a case of eptifibatide-induced thrombocytopenia complicated by gastrointestinal bleeding to the medical literature. It highlights the need for complex decision-making regarding cessation of antiplatelet therapy in patients with recent percutaneous coronary intervention and the lack of robust evidence for the benefit of GP IIb/IIIa inhibitors in the ticagrelor era when compared to clopidogrel and aspirin.