Thromboembolic events secondary to tirofiban-induced thrombocytopenia being treated with thrombopoietin: A case report

Abstract

A 68-year-old man presented with acute coronary syndrome (ACS). The glycoprotein/IIb/IIIa receptor antagonist tirofiban was administered to the patient to treat a right coronary artery slow flow detected during percutaneous coronary intervention. The patient developed very severe thrombocytopenia 8 h after tirofiban infusion with no signs of bleeding. Antiplatelet medication was discontinued immediately, methylprednisolone was administered and platelets were transfused. Thrombopoietin (TPO) was also applied to the patient as recommended by a hematology consultant. As a result, the patient had in-stent thrombosis and cerebral infarction, then another sirolimus-eluting stent was implanted in the proximal right coronary artery and intensive anti-platelet as well as intermittent dehydration to reduce intracranial pressure, and protection of the nervous system function treatment was also provided. The patient was left with a decreased muscle strength in the right limb muscle and fine movement disorder, which may have lead to a poor prognosis. To the best of our knowledge, this is the first case report of tirofiban-induced severe thrombocytopenia with secondary in-stent thrombosis and cerebral infarction from China. The experience of the diagnosis and treatment of this case may shed some light on the clinical use of TPO in tirofiban-induced thrombocytopenia.