Skip to main content
Top
Published in: Journal of Thrombosis and Thrombolysis 2/2008

01-04-2008

Eptifibatide-induced thrombocytopenia

Authors: Marwan Refaat, A. J. Conrad Smith, Daniel Edmundowicz

Published in: Journal of Thrombosis and Thrombolysis | Issue 2/2008

Login to get access

Abstract

Glycoprotein (GP) IIb/IIIa inhibitors reduce major adverse coronary events in patients with acute coronary syndromes undergoing percutaneous coronary interventions (PCI). Unlike the other GPIIb/IIIa inhibitors, eptifibatide is rarely associated with thrombocytopenia with only a few cases reported in the medical literature. Here we report a case of a 34-year-old man presenting with a non ST-elevation myocardial infarction (NSTEMI) who underwent primary PCI with stenting and developed stent thrombosis 5 days after the procedure. He underwent repeat PCI with readministration of eptifibatide and subsequently developed profound thrombocytopenia within 4 h. This report adds another case of eptifibatide associated thrombocytopenia to the literature and reinforces the importance of platelet count monitoring after therapy with this agent.
Literature
2.
go back to reference 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):1559–1562PubMedCrossRef 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):1559–1562PubMedCrossRef
3.
go back to reference 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):479–484PubMedCrossRef 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):479–484PubMedCrossRef
4.
go back to reference The PURSUIT Trial Investigators (1998) Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes. Platelet glycoprotein IIb/IIIa in unstable angina: receptor suppression using integrilin therapy. N Engl J Med 339(7):436–443CrossRef The PURSUIT Trial Investigators (1998) Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes. Platelet glycoprotein IIb/IIIa in unstable angina: receptor suppression using integrilin therapy. N Engl J Med 339(7):436–443CrossRef
5.
go back to reference Carborough 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 Carborough 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
6.
go back to reference 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):870–875PubMedCrossRef 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):870–875PubMedCrossRef
7.
go back to reference 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):205–208PubMedCrossRef 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):205–208PubMedCrossRef
8.
go back to reference 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):453–455PubMedCrossRef 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):453–455PubMedCrossRef
9.
go back to reference 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):1888–1894PubMedCrossRef 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):1888–1894PubMedCrossRef
10.
go back to reference The IMPACT-II Investigators (1997) Randomised placebo-controlled trial of effect of eptifibatide on complications of percutaneous coronary intervention: IMPACT-II. Integrilin to minimise platelet aggregation and coronary thrombosis-II. Lancet 349(9063):1422–1428 The IMPACT-II Investigators (1997) Randomised placebo-controlled trial of effect of eptifibatide on complications of percutaneous coronary intervention: IMPACT-II. Integrilin to minimise platelet aggregation and coronary thrombosis-II. Lancet 349(9063):1422–1428
11.
go back to reference 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):2468–2473PubMedCrossRef 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):2468–2473PubMedCrossRef
12.
go back to reference Epelman S, Nair D, Downey R, Militello M, Askari A (2006) Eptifibatide-induced thrombocytopenia and thrombosis. J Thromb Thrombolysis 22:151–154PubMedCrossRef Epelman S, Nair D, Downey R, Militello M, Askari A (2006) Eptifibatide-induced thrombocytopenia and thrombosis. J Thromb Thrombolysis 22:151–154PubMedCrossRef
13.
go back to reference Rezkalla SH, Hayes JJ, Curtis BR, Aster RH (2003) Eptifibatide induced acute profound thrombocytopenia presenting as refractory hypotension. Catheter Cardiovasc Interv 58(1):76–79PubMedCrossRef Rezkalla SH, Hayes JJ, Curtis BR, Aster RH (2003) Eptifibatide induced acute profound thrombocytopenia presenting as refractory hypotension. Catheter Cardiovasc Interv 58(1):76–79PubMedCrossRef
14.
go back to reference Coons JC, Barcelona RA, Freedy T, Hagerty MF (2005) Eptifibatide-associated acute, profound thrombocytopenia. Ann Pharmacother 39(2):368–372PubMedCrossRef Coons JC, Barcelona RA, Freedy T, Hagerty MF (2005) Eptifibatide-associated acute, profound thrombocytopenia. Ann Pharmacother 39(2):368–372PubMedCrossRef
15.
go back to reference Salengro E, Mulvihill NT, Farah B (2003) Acute profound thrombocytopenia after use of eptifibatide for coronary stenting. Catheter Cardiovasc Interv 58(1):73–75PubMedCrossRef Salengro E, Mulvihill NT, Farah B (2003) Acute profound thrombocytopenia after use of eptifibatide for coronary stenting. Catheter Cardiovasc Interv 58(1):73–75PubMedCrossRef
16.
go back to reference Yoder M, Edwards RF (2002) Reversible thrombocytopenia associated with eptifibatide. Ann Pharmacother 36(4):628–630PubMedCrossRef Yoder M, Edwards RF (2002) Reversible thrombocytopenia associated with eptifibatide. Ann Pharmacother 36(4):628–630PubMedCrossRef
17.
go back to reference Tanaka KA, Vega JD, Kelly AB, Hanson SR, Levy JH (2003) Eptifibatide-induced thrombocytopenia and coronary bypass operation. J Thromb Haemost 1(2):392–394PubMedCrossRef Tanaka KA, Vega JD, Kelly AB, Hanson SR, Levy JH (2003) Eptifibatide-induced thrombocytopenia and coronary bypass operation. J Thromb Haemost 1(2):392–394PubMedCrossRef
18.
go back to reference Nagge J, Jackevicius C, Dzavik V, Ross JR, Seidelin P (2003) Acute profound thrombocytopenia associated with eptifibatide therapy. Pharmacotherapy 23(3):374–379PubMedCrossRef Nagge J, Jackevicius C, Dzavik V, Ross JR, Seidelin P (2003) Acute profound thrombocytopenia associated with eptifibatide therapy. Pharmacotherapy 23(3):374–379PubMedCrossRef
19.
go back to reference Khaykin Y, Paradiso-Hardy FL, Madan M (2003) Acute thrombocytopenia associated with eptifibatide therapy. Can J Cardiol 19(7):797–801PubMed Khaykin Y, Paradiso-Hardy FL, Madan M (2003) Acute thrombocytopenia associated with eptifibatide therapy. Can J Cardiol 19(7):797–801PubMed
20.
go back to reference 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):2071–2076PubMed 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):2071–2076PubMed
21.
go back to reference 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):1095–1102PubMed 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):1095–1102PubMed
22.
go back to reference Hayward CP (2004) Further complexities in diagnosing acquired thrombocytopenia: unexpected parallels between antibodymediated delayed thrombocytopenia with abciximab and heparin induced thrombocytopenia. Thromb Haemost 92(4):674–675PubMed Hayward CP (2004) Further complexities in diagnosing acquired thrombocytopenia: unexpected parallels between antibodymediated delayed thrombocytopenia with abciximab and heparin induced thrombocytopenia. Thromb Haemost 92(4):674–675PubMed
23.
go back to reference 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):2054–2059PubMedCrossRef 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):2054–2059PubMedCrossRef
Metadata
Title
Eptifibatide-induced thrombocytopenia
Authors
Marwan Refaat
A. J. Conrad Smith
Daniel Edmundowicz
Publication date
01-04-2008
Publisher
Springer US
Published in
Journal of Thrombosis and Thrombolysis / Issue 2/2008
Print ISSN: 0929-5305
Electronic ISSN: 1573-742X
DOI
https://doi.org/10.1007/s11239-007-0166-x

Other articles of this Issue 2/2008

Journal of Thrombosis and Thrombolysis 2/2008 Go to the issue
Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin
Prof. Florian Limbourg
Prof. Anoop Chauhan
Developed by: Springer Medicine
Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Highlights from the ACC 2024 Congress

Year in Review: Pediatric cardiology

Watch Dr. Anne Marie Valente present the last year's highlights in pediatric and congenital heart disease in the official ACC.24 Year in Review session.

Year in Review: Pulmonary vascular disease

The last year's highlights in pulmonary vascular disease are presented by Dr. Jane Leopold in this official video from ACC.24.

Year in Review: Valvular heart disease

Watch Prof. William Zoghbi present the last year's highlights in valvular heart disease from the official ACC.24 Year in Review session.

Year in Review: Heart failure and cardiomyopathies

Watch this official video from ACC.24. Dr. Biykem Bozkurt discusses last year's major advances in heart failure and cardiomyopathies.