Antiplatelet therapy and percutaneous coronary intervention: In patients with acute coronary syndrome and thrombocytopenia

Department of Cardiology, University of Texas M.D. Anderson Cancer Center, Houston, Texas 77030, USA.
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital (Impact Factor: 0.65). 01/2010; 37(3):336-40.
Source: PubMed


Platelets are crucial in the pathogenesis of acute coronary syndrome. Treatment for acute coronary syndrome usually involves antiplatelet, anticoagulant, and antithrombotic therapy, and the performance of percutaneous coronary intervention. All of the medications are associated with bleeding sequelae and are typically withheld from patients who have thrombocytopenia. The safety of antiplatelet therapy and percutaneous coronary intervention in patients who have acute coronary syndrome and thrombocytopenia is unknown, and there are no guidelines or randomized studies to suggest a treatment approach in such patients. Acute coronary syndrome is uncommon in patients who have thrombocytopenia; however, it occurs in up to 39% of patients who have both thrombocytopenia and cancer. Herein, we present the cases of 5 patients with acute coronary syndrome, thrombocytopenia, and cancer who underwent percutaneous coronary intervention with stenting. Before intervention, their platelet counts ranged from 17 to 72 x 10(9)/L. One patient underwent preprocedural platelet transfusion. All were given aspirin, alone or with clopidogrel. One patient experienced melena (of colonic origin). No other patient experienced bleeding sequelae. Aside from the occasional use of antiplatelet and thrombolytic agents in patients with thrombocytopenia, no therapeutic recommendation can be made until data are available on a larger patient population. Until then, treatment should conform to specific clinical circumstances. Approaches to the treatment of acute coronary syndrome in patients with thrombocytopenia might be better directed toward the evaluation of platelet function rather than toward absolute platelet count, and the risk-benefit equation of invasive procedures and antithrombotic therapies may need to incorporate this information.

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    Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital 01/2011; 38(3):259-60. · 0.65 Impact Factor
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    ABSTRACT: Background: Platelets play a pivotal role in the pathogenesis of acute coronary syndrome (ACS) and acute and chronic complications following percutaneous coronary intervention (PCI). Platelet inhibition is a cornerstone in the management of these patients. Idiopathic thrombocytopenic purpura (ITP) is a bleeding disorder characterized by premature platelet destruction mediated by autoantibodies. The safety of antiplatelet therapy and PCI in patients who have ACS and ITP is unknown. The aim of the present study is to discuss the management strategies for patients who have ACS and ITP and to review limited data available in the literature. Case presentation: We report the case of a patient with ITP who underwent three separate coronary interventions. The first PCI with stenting was performed in the left anterior descending artery 5 years ago while the patient suffered an anterior acute myocardial infarction, and the platelet count at admission was 90 × 10(9)/L. The patient presented with recurrent ACS and severe in-stent restenosis 5 years after the first PCI, and the platelet count at admission was 18 × 10(9)/L, and elevated to 87 × 10(9)/L after platelets transfusion. He was treated successfully with cutting balloon angioplasty under anticoagulation with unfractionated heparin and antiagregation with acetylsalicylic acid and clopidogrel. Four months later after cutting balloon angioplasty, the patient received an intracoronary stent when he once again presented with recurrent ACS in the setting of restenosis. The patient has been observed for 1.5 years without restenosis after the third PCI. Conclusion: We reviewed all the cases in the literature involving PCI and discussed the management strategies in patients with ITP and ACS. Available data suggest that PCI can be safe and feasible, and the risk-benefit equation of PCI procedures and antiplatelet therapies should be carefully evaluated, and the treatment should be individualized.
    BMC Cardiovascular Disorders 09/2015; 15(1):101. DOI:10.1186/s12872-015-0092-3 · 1.88 Impact Factor