Abstract
We describe the case of a 69-year-old man who developed glycoprotein IIb/IIIa receptor (GPIIb/IIIa) antagonist associated thrombocytopenia and the successful management during urgent aortic dissection and coronary artery bypass grafting. A flow cytometric assay was developed to confirm the diagnosis of GPIIb/IIIa-antagonist induced thrombocytopenia. This case was further complicated by the concomitant presence of heparine/PF4 platelet antibodies, but was proven not to be the causal factor of the thrombocytopenia.
Highlights
Problems related to the use of glycoprotein IIb/IIIa(GPIIb/IIIa) receptor antagonists, such as abciximab, eptifibatide and tirofiban, are not infrequent [1] and could have a major impact on the clinical course of an often critically ill patient
We describe a patient in whom severe thrombocytopenia was diagnosed, the cause was initially unclear
GPIIb/IIIa antagonists are widely used in the management of a variety of patients with acute coronary syndromes; they prevent platelet aggregation and thrombus formation, thereby improving outcomes of these patients [3]. Therapy with these agents may lead to bleeding complications and in rare cases to thrombocytopenia, challenging the perioperative management of these patients
Summary
Problems related to the use of glycoprotein IIb/IIIa(GPIIb/IIIa) receptor antagonists, such as abciximab, eptifibatide and tirofiban, are not infrequent [1] and could have a major impact on the clinical course of an often critically ill patient. We describe a patient in whom severe thrombocytopenia was diagnosed, the cause was initially unclear. Both heparin-induced thrombocytopenia and GPIIb/IIIa antagonist related antibodies obscured the picture, along with other possible causes of thrombocytopenia
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