Management of acute myocardial infarction in a patient with idiopathic thrombocytopenic purpura, the value of optical coherence tomography: a case report

Abstract

Background Treating myocardial infarction in the setting of immune thrombocytopenic purpura (ITP) is always a challenge especially if the platelet count is labile. Cardiologists dealing with such patients should keep a delicate balance between thrombotic and bleeding complications. Case summary A 50-year-old gentleman with treatment-challenging ITP presented with acute inferior ST elevation myocardial infarction after receiving recent intravenous immunoglobulin. Using optical coherence tomography (OCT) guidance, it was decided to treat him with percutaneous old balloon angioplasty especially with the labile nature of his platelet count. Subsequently, dual antiplatelet therapy was a challenge and he remained on clopidogrel for a period of only 10 weeks. Conclusion This case highlights the rare presentation of patients with ITP with thrombotic complications and the usefulness of OCT in formulating a management plan.

Invasive management of non-ST elevation myocardial infarction (NSTEMI) in a patient with severe thrombocytopenia secondary to adult-onset immune thrombocytopenic purpura

“…This showed good stent apposition, which is an important factor to reduce the risk of stent thrombosis 3. Another case report highlighted the increased thrombotic potential where a patient presented with STEMI 7 days after IVIg administration for ITP 5. These case reports show an increased incidence of acute infarcts, whether as acute stent thrombosis or de novo thrombosis in coronary artery, following IVIg therapy 3 5.…”

“…Immune thrombocytopenic purpura (ITP) represents one of the causes of thrombocytopenia with an underlying autoantibody-mediated mechanism 4. Patients with ACS and ITP undergoing invasive management can represent a challenge as an imbalance between the platelet levels and the antiplatelet medications may lead to life-threatening bleeding or thrombosis 5. We present such a case below.…”

ST-segment elevation myocardial infarction with plaque erosion, to stent or not to stent: utility of intracoronary optical coherence tomography (OCT) imaging—a case report

“…This strategy has been useful in a previous case of acute myocardial infarction with OCT proven plaque erosion, in this case, the avoidance of a stent was principally due to idiopathic thrombocytopenic purpura with uneventful follow-up at 1 year. 12 …”

Antiplatelet therapy in patients with acute coronary syndromes and thrombocytopaenia: awaiting for evidence

“…present the case of a young patient with ST-elevation myocardial infarction (STEMI) in the context of extreme fluctuations of platelet count (from 1 to 658 × 10 9 /L) due to treatment-resistant immune thrombocytopaenic purpura (ITP). 9 The patient experienced an ACS shortly after a rescue therapy with intravenous immunoglobulins, which resulted in transient rebound thrombocytosis. Diagnostic coronary angiography was here complemented by optical coherence tomography (OCT), which revealed the presence of a coronary erosion as the putative cause of the index ACS.…”

“…In this context, considering the clinical relevance of the topic and the lack of a clear consensus on the best treatment strategies, case reports like the one by Al-Lawati et al . 9 should stimulate discussion and prompt, because of the impracticality of randomized trials, the establishment of dedicated multi-national registries collecting information on the management of patients with ACS and severe thrombocytopaenia.…”