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Eptifibatide-induced thrombocytopenia and thrombosis

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Abstract

Glycoprotein (GP) IIb/IIIa inhibitors have been shown to reduce morbidity and mortality in patients with acute coronary syndromes undergoing percutaneous coronary interventions (PCI). With their widespread use, there is a growing body of literature describing adverse outcomes, including severe thrombocytopenia. Here we report a case of a 75-year-old man who presented with an ST-elevation myocardial infarction, underwent primary PCI and stenting, and subsequently developed profound thrombocytopenia and thrombosis after eptifibatide administration. This report adds to the literature regarding eptifibatide-induced thrombocytopenia and also raises the possibility of a new syndrome of eptifibatide-induced thrombosis. A case is made to examine available databases for thrombosis after administration of eptifibatide and other GPIIb/IIIa inhibitors.

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References

  1. Coller BS (1990) Platelets and thrombolytic therapy. N Engl J Med 322(1):33–42

    Article  PubMed  CAS  Google Scholar 

  2. Scarborough RM, Rose JW, Hsu MA, Phillips DR, Fried VA, Campbell AM, et al (1991) Barbourin. A GPIIb-IIIa-specific integrin antagonist from the venom of Sistrurus m. barbouri. J Biol Chem 266(15):9359–9362

    PubMed  CAS  Google Scholar 

  3. Pytela R, Pierschbacher MD, Ginsberg MH, Plow EF, Ruoslahti E (1986) Platelet membrane glycoprotein IIb/IIIa: member of a family of Arg-Gly-Asp-specific adhesion receptors. Science 231(4745):1559–1562

    PubMed  CAS  Google Scholar 

  4. Topol EJ, Ferguson JJ, Weisman HF, Tcheng JE, Ellis SG, Kleiman NS, et al (1997) Long-term protection from myocardial ischemic events in a randomized trial of brief integrin beta3 blockade with percutaneous coronary intervention. EPIC Investigator Group. Evaluation of Platelet IIb/IIIa Inhibition for Prevention of Ischemic Complication. JAMA 278(6):479–484

    Article  PubMed  CAS  Google Scholar 

  5. Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes (1998) The PURSUIT Trial Investigators. Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy. N Engl J Med 339(7):436–443

    Article  Google Scholar 

  6. Aster RH (2005) Immune thrombocytopenia caused by glycoprotein IIb/IIIa inhibitors. Chest 127(2 Suppl):53S–59S

    Google Scholar 

  7. Tcheng JE, Kereiakes DJ, Lincoff AM, George BS, Kleiman NS, Sane DC, et al (2001) Abciximab readministration: results of the ReoPro Readministration Registry. Circulation 104(8):870–875

    PubMed  CAS  Google Scholar 

  8. Jubelirer SJ, Koenig BA, Bates MC (1999) Acute profound thrombocytopenia following C7E3 Fab (Abciximab) therapy: Case reports, review of the literature and implications for therapy. Am J Hematol 61(3):205–208

    Google Scholar 

  9. Fahdi IE, Saucedo JF, Hennebry T, Ghani M, Sadanandan S, Garza-Arreola L (2004) Incidence and time course of thrombocytopenia with abciximab and eptifibatide in patients undergoing percutaneous coronary intervention. Am J Cardiol 93(4):453–455

    Article  PubMed  CAS  Google Scholar 

  10. Topol EJ, Moliterno DJ, Herrmann HC, Powers ER, Grines CL, Cohen DJ, et al (2001) Comparison of two platelet glycoprotein IIb/IIIa inhibitors, tirofiban and abciximab, for the prevention of ischemic events with percutaneous coronary revascularization. N Engl J Med 344(25):1888–1894

    Article  PubMed  CAS  Google Scholar 

  11. Randomised placebo-controlled trial of effect of eptifibatide on complications of percutaneous coronary intervention: IMPACT-II (1997) Integrilin to Minimise Platelet Aggregation and Coronary Thrombosis-II. Lancet 349(9063):1422–1428

    Google Scholar 

  12. O’Shea JC, Hafley GE, Greenberg S, Hasselblad V, Lorenz TJ, Kitt MM, et al (2001) Platelet glycoprotein IIb/IIIa integrin blockade with eptifibatide in coronary stent intervention: The ESPRIT trial: A randomized controlled trial. JAMA 285(19):2468–2473

    Article  PubMed  CAS  Google Scholar 

  13. Rezkalla SH, Hayes JJ, Curtis BR, Aster RH (2003) Eptifibatide-induced acute profound thrombocytopenia presenting as refractory hypotension. Catheter Cardiovasc Interv 58(1):76–79

    Article  PubMed  Google Scholar 

  14. Coons JC, Barcelona RA, Freedy T, Hagerty MF (2005) Eptifibatide-associated acute, profound thrombocytopenia. Ann Pharmacother 39(2):368–372

    Article  PubMed  Google Scholar 

  15. Salengro E, Mulvihill NT, Farah B (2003) Acute profound thrombocytopenia after use of eptifibatide for coronary stenting. Catheter Cardiovasc Interv 58(1):73–75

    Article  PubMed  Google Scholar 

  16. Yoder M, Edwards RF (2002) Reversible thrombocytopenia associated with eptifibatide. Ann Pharmacother 36(4):628–630

    Article  PubMed  Google Scholar 

  17. Tanaka KA, Vega JD, Kelly AB, Hanson SR, Levy JH (2003) Eptifibatide-induced thrombocytopenia and coronary bypass operation. J Thromb Haemost 1(2):392–394

    Article  PubMed  CAS  Google Scholar 

  18. Khaykin Y, Paradiso-Hardy FL, Madan M (2003) Acute thrombocytopenia associated with eptifibatide therapy. Can J Cardiol 19(7):797–801

    PubMed  CAS  Google Scholar 

  19. Nagge J, Jackevicius C, Dzavik V, Ross JR, Seidelin P (2003) Acute profound thrombocytopenia associated with eptifibatide therapy. Pharmacotherapy 23(3):374–379

    Article  PubMed  Google Scholar 

  20. Greinacher A, Michels I, Mueller-Eckhardt C (1992) Heparin-associated thrombocytopenia: The antibody is not heparin specific. Thromb Haemost 67(5):545–549

    PubMed  CAS  Google Scholar 

  21. Horsewood P, Warkentin TE, Hayward CP, Kelton JG (1996) The epitope specificity of heparin-induced thrombocytopenia. Br J Haematol 95(1):161–167

    Article  PubMed  CAS  Google Scholar 

  22. Ziporen L, Li ZQ, Park KS, Sabnekar P, Liu WY, Arepally G, et al (1998) Defining an antigenic epitope on platelet factor 4 associated with heparin-induced thrombocytopenia. Blood 92(9):3250–3259

    PubMed  CAS  Google Scholar 

  23. Bougie DW, Wilker PR, Wuitschick ED, Curtis BR, Malik M, Levine S, et al (2002) Acute thrombocytopenia after treatment with tirofiban or eptifibatide is associated with antibodies specific for ligand-occupied GPIIb/IIIa. Blood 100(6):2071–2076

    PubMed  CAS  Google Scholar 

  24. Jennings LK, Haga JH, Slack SM (2000) Differential expression of a ligand induced binding site (LIBS) by GPIIb-IIIa ligand recognition peptides and parenteral antagonists. Thromb Haemost 84(6):1095–1102

    PubMed  CAS  Google Scholar 

  25. Hayward CP (2004) Further complexities in diagnosing acquired thrombocytopenia: Unexpected parallels between antibody-mediated delayed thrombocytopenia with abciximab and heparin induced thrombocytopenia. Thromb Haemost 92(4):674–675

    PubMed  CAS  Google Scholar 

  26. Curtis BR, Swyers J, Divgi A, McFarland JG, Aster RH (2002) Thrombocytopenia after second exposure to abciximab is caused by antibodies that recognize abciximab-coated platelets. Blood 99(6):2054–2059

    Article  PubMed  CAS  Google Scholar 

  27. Warkentin TE, Hayward CP, Boshkov LK, Santos AV, Sheppard JA, Bode AP, et al (1994) Sera from patients with heparin-induced thrombocytopenia generate platelet-derived microparticles with procoagulant activity: An explanation for the thrombotic complications of heparin-induced thrombocytopenia. Blood 84(11):3691–3699

    PubMed  CAS  Google Scholar 

  28. Morel O, Jesel L, Chauvin M, Freyssinet JM, Toti F (2003) Eptifibatide-induced thrombocytopenia and circulating procoagulant platelet-derived microparticles in a patient with acute coronary syndrome. J Thromb Haemost 1(12):2685–2687

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Internal Medicine, The Cleveland Clinic, Cleveland

    Slava Epelman

  2. Department of Cardiovascular Medicine, The Cleveland Clinic, Cleveland

    Deepu Nair, Ross Downey & Arman T. Askari (Staff Physician, Associate Director)

  3. Department of Pharmacy, The Cleveland Clinic, Cleveland

    Mike Militello

  4. Section of Clinical Cardiology, Cardiovascular Medicine Training Program, The Cleveland Clinic Foundation, 9500 Euclid Avenue/Desk F15, Cleveland, OH, 44195

    Arman T. Askari (Staff Physician, Associate Director)

Authors
  1. Slava Epelman
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  2. Deepu Nair
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  3. Ross Downey
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  4. Mike Militello
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  5. Arman T. Askari
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Corresponding author

Correspondence to Arman T. Askari.

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Epelman, S., Nair, D., Downey, R. et al. Eptifibatide-induced thrombocytopenia and thrombosis. J Thromb Thrombolysis 22, 151–154 (2006). https://doi.org/10.1007/s11239-006-8785-1

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  • DOI: https://doi.org/10.1007/s11239-006-8785-1

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