A case of profound and prolonged tirofiban‐induced thrombocytopenia and its correction by intravenous immunoglobulin G

Clofent‐Sanchez, Gisèle; Harizi, Hedi; Nurden, Alan T.; Coste, Pierre; Jais, Catherine; Nurden, Paquita

doi:10.1111/j.1538-7836.2007.02440.x

Cited by 16 publications

(7 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Considering the clinical scenario in this patient, tirofiban-induced thrombocytopenia was more likely and our hypothesis was supported by the fact that on discontinuation of tirofiban treatment platelet count rapidly improved. Clofent-Sanchez et al validated their hypothesis that tirofiban led to profound drug-induced thrombocytopenia by confirming the presence of antibodies using enzyme-linked immunoassay (ELISA) and flow cytometry [17].…”

Section: Discussionmentioning

confidence: 97%

Tirofiban: A Rare Cause of Thrombocytopenia in a Patient Undergoing Percutaneous Coronary Intervention

Gulati¹,

Tiwari²,

Shetty³

et al. 2021

Cureus

View full text Add to dashboard Cite

Patients admitted to the hospital can develop thrombocytopenia due to multifactorial causes. It can be pseudo-thrombocytopenia or true thrombocytopenia. Among patients admitted for chest pain, coronary angiography (CAG) is a common diagnostic test to evaluate patients for coronary artery disease (CAD). Normally, patients undergoing angiogram receive antiplatelets and anticoagulants pre-catheterization, and platelet aggregation inhibitor agents are sometimes used during and after CAG like in patients with high thrombus burden. Glycoprotein IIb/IIIa receptor inhibitors are a type of platelet antiaggregant agents that can cause severe thrombocytopenia in few cases.We present a case of a 68-year-old patient who came to the emergency department with inferior wall STsegment elevation myocardial infarction and underwent angiography and had percutaneous coronary intervention (PCI) done. He was administered tirofiban during the angiogram that caused acute severe thrombocytopenia decreasing platelets count to 4000/microliter within one day. Patients' platelets gradually recovered after platelets transfusion.

show abstract

Section: Discussionmentioning

confidence: 97%

Tirofiban: A Rare Cause of Thrombocytopenia in a Patient Undergoing Percutaneous Coronary Intervention

Gulati¹,

Tiwari²,

Shetty³

et al. 2021

Cureus

View full text Add to dashboard Cite

show abstract

“…To validate the hypothesis that tirofiban is, in fact, the offending agent, a case reported in 2007 employed ELISA and flow cytometry to confirm the drug-dependent antibodies were indeed formed only in the presence of tirofiban [9].…”

Section: Discussionmentioning

confidence: 99%

Tirofiban Induced Thrombocytopenia: A Rare but Severe Adverse Effect

Rawala

Ahmed

Posina

et al. 2020

Journal of Community Hospital Internal Medicine Perspectives

View full text Add to dashboard Cite

With the advent of medical technology, coronary angiography is a common practice to evaluate patient for coronary artery disease. Normally, patients undergoing angiogram receive antiplatelets, anticoagulants, and platelet aggregation inhibitor agents. Glycoprotein IIb/IIIa receptor inhibitors are a type of platelets antiaggregant agents that can cause severe thrombocytopenia in very few cases. We present a case of a 69-year-old female who presented with chest pain, underwent an angiography and had two stents placed. She was administered tirofiban during angiogram that caused acute severe thrombocytopenia decreasing her platelets count from 224 to 2 k/mm 3 within 1 day. Patients platelets gradually recovered after trial of steroid and platelets transfusion. Antiplatelets (Aspirin and Clopidogrel) were resumed; however, patient's platelets remained stable.

show abstract

“… 26 Additional cases of variably severe thrombocytopenia in association with tirofiban treatment have been reported, including 1 patient who developed hypotension, rigors, and chills soon after drug administration and 1 who developed fatal pulmonary hemorrhage. 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 …”

Section: Gpi ‐Associated Thrombocytopeniamentioning

confidence: 99%

Critical Analysis of Thrombocytopenia Associated With Glycoprotein IIb/IIIa Inhibitors and Potential Role of Zalunfiban, a Novel Small Molecule Glycoprotein Inhibitor, in Understanding the Mechanism(s)

Rikken,

van 't Hof,

ten Berg

et al. 2023

JAHA

View full text Add to dashboard Cite

Thrombocytopenia is a rare but serious complication of the intravenous glycoprotein IIb/IIIa (GPIIb/IIIa; integrin αIIbβ3) receptor inhibitors (GPIs), abciximab, eptifibatide, and tirofiban. The thrombocytopenia ranges from mild (50 000–100 000 platelets/μL), to severe (20 000 to <50 000/μL), to profound (<20 000/μL). Profound thrombocytopenia appears to occur in <1% of patients receiving their first course of therapy. Thrombocytopenia can be either acute (<24 hours) or delayed (up to ~14 days). Both hemorrhagic and thrombotic complications have been reported in association with thrombocytopenia. Diagnosis requires exclusion of pseudothrombocytopenia and heparin‐induced thrombocytopenia. Therapy based on the severity of thrombocytopenia and symptoms may include drug withdrawals and treatment with steroids, intravenous IgG, and platelet transfusions. Abciximab‐associated thrombocytopenia is most common and due to either preformed antibodies or antibodies induced in response to abciximab (delayed). Readministration of abciximab is associated with increased risk of thrombocytopenia. Evidence also supports an immune basis for thrombocytopenia associated with the 2 small molecule GPIs. The latter bind αIIbβ3 like the natural ligands and thus induce the receptor to undergo major conformational changes that potentially create neoepitopes. Thrombocytopenia associated with these drugs is also immune‐mediated, with antibodies recognizing the αIIbβ3 receptor only in the presence of the drug. It is unclear whether the antibody binding depends on the conformational change and whether the drug contributes directly to the epitope. Zalunfiban, a second‐generation subcutaneous small molecule GPI, does not induce the conformational changes; therefore, data from studies of zalunfiban will provide information on the contribution of the conformational changes to the development of GPI‐associated thrombocytopenia.

show abstract

A case of profound and prolonged tirofiban‐induced thrombocytopenia and its correction by intravenous immunoglobulin G

Cited by 16 publications

References 12 publications

Tirofiban: A Rare Cause of Thrombocytopenia in a Patient Undergoing Percutaneous Coronary Intervention

Tirofiban: A Rare Cause of Thrombocytopenia in a Patient Undergoing Percutaneous Coronary Intervention

Tirofiban Induced Thrombocytopenia: A Rare but Severe Adverse Effect

Critical Analysis of Thrombocytopenia Associated With Glycoprotein IIb/IIIa Inhibitors and Potential Role of Zalunfiban, a Novel Small Molecule Glycoprotein Inhibitor, in Understanding the Mechanism(s)

Contact Info

Product

Resources

About