Skip to main content
SpringerLink
Log in

Primary PCI for Acute Myocardial Infarction in a Patient with Idiopathic Thrombocytopenic Purpura

A Case Report and Review of the Literature

Primäre PCI wegen akuten Myokardinfarkts bei einem Patienten mit idiopathischer thrombozytopenischer Purpura. Fallbericht und Literaturübersicht

  • Published:
Herz Aims and scope Submit manuscript

Abstract

Background and Purpose:

The occurrence of acute myocardial infarction (AMI) in patients with idiopathic thrombocytopenic purpura (ITP) is rare, especially when the platelet count is low. Since only few case reports have been published, there are no recommendations for the management of thrombocytopenic patients with AMI. The aim of the present study is to discuss different aspects of this challenging issue and to review limited data available in the literature.

Case Study:

An 80-year-old patient with ITP (platelet count 5 . 109/l) is presented who developed an AMI (ST segment elevation myocardial infarction) and was successfully treated by primary percutaneous coronary intervention (PCI).

Conclusion:

Considering the high bleeding risk in patients with ITP and AMI, careful balance between usual anticoagulation and antiplatelet therapy on the one hand, and efforts to raise platelet count on the other hand are needed.

Zusammenfassung

Hintergrund und Fragestellung:

Akute Myokardinfarkte (AMI) bei Patienten mit idiopathischer thrombozytopenischer Purpura (ITP, Morbus Werlhof) sind seltene Ereignisse. Da in der Literatur nur einige wenige Fälle beschrieben sind, existieren auch keine Therapieempfehlungen für diese Konstellation. In der vorliegenden Studie sollen unterschiedliche Aspekte dieser herausfordernden Situation diskutiert und die verfügbaren Daten aus der Literatur zusammenfassend beschrieben werden.

Fallbericht:

Geschildert wird der Fall eines 80-jährigen Patienten mit ITP (Thrombozytenzahl 5 . 109/l), der einen AMI (ST-Strecken-Hebungsinfarkt) erlitten hatte und mit primärer perkutaner Koronarintervention (PCI) erfolgreich behandelt wurde.

Schlussfolgerung:

Das hohe Blutungsrisiko bei Patienten mit ITP und AMI erfordert eine sorgfältige Balance zwischen Antikoagulation bzw. Plättchenhemmung einerseits und Anhebung der Thrombozytenzahl andererseits.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cines DB, Blanchette VS. Immune thrombocytopenic purpura. N Engl J Med 2002;346:995–1008.

    Article  PubMed  Google Scholar 

  2. George JN, El-Harake MA, Aster RH. Thrombocytopenia due to enhanced platelet destruction by immunologic mechanisms. In: Beutler E, Lichtman MA, Coller BS, Kipps TJ, eds. Williams hematology. New York: McGraw-Hill, 1995:1315.

    Google Scholar 

  3. Araki T, Tofuku Y. An elderly case of idiopathic thrombocytopenic purpura associated with acute myocardial infarction [Abstract]. Nippon Ronen Igakkai Zasshi 1999;36:742–6.

    CAS  PubMed  Google Scholar 

  4. Zelcer S, Bussel JB. Thrombosis in patients with immune thrombocytopenic purpura (ITP): a case series. J Thromb Haemost 2003;1:Suppl 1:abstract 1169.

  5. Stenton SB, Dalen D, Wilbur K. Myocardial infarction associated with intravenous immune globulin. Ann Pharmacother 2005;39:2114–8.

    Article  PubMed  Google Scholar 

  6. Rand ML, Dean JA. Platelet function in autoimmune (idiopathic) thrombocytopenic purpura. Acta Paediatr 1998;424:Suppl:57–60.

    CAS  Google Scholar 

  7. Thiagarajan P, Shapiro SS, Levine E, et al. A monoclonal antibody to human platelet glycoprotein IIIa detects a related protein in cultured human endothelial cells. J Clin Invest 1985;75:896–901.

    Article  CAS  PubMed  Google Scholar 

  8. Leeksma OC, Zandbergen-Spaargaren J, Giltay JC, et al. Cultured human endothelial cells synthesize a plasma membrane protein complex immunologically related to the platelet glycoprotein IIb/IIIa complex. Blood 1986;67:1176–80.

    CAS  PubMed  Google Scholar 

  9. Sprandio JD, Shapiro SS, Thiagarajan P, et al. Cultured human umbilical vein endothelial cells contain a membrane glycoprotein immunologically related to platelet glycoprotein Ib. Blood 1988;71:234–7.

    CAS  PubMed  Google Scholar 

  10. Giltay JC, Brinkman HJ, Modderman PW, et al. Human vascular endothelial cells express a membrane protein complex immunochemically indistinguishable from the platelet VLA-2 (glycoprotein Ia–IIa) complex. Blood 1989;73:1235–41.

    CAS  PubMed  Google Scholar 

  11. Antman EM, Hand M, Armstrong PW, et al. 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction, writing on behalf of the 2004 Writing Committee. Circulation 2008;117:296–329.

    Article  PubMed  Google Scholar 

  12. Koike R, Suma H, Oku T, et al. Combined coronary revascularization and splenectomy. Ann Thorac Surg 1989;48:853–4.

    Article  CAS  PubMed  Google Scholar 

  13. Bowman GA. Coronary artery bypass grafting without splenectomy. Ann Thorac Surg 1990;50:330–1.

    Article  CAS  PubMed  Google Scholar 

  14. Terada Y, Ino T, Wanibuchi Y, et al. A case of CABG in a patient with chronic idiopathic thrombocytopenic purpura [Abstract]. Nippon Kyobu Geka Gakkai Zasshi 1990;38:150–3.

    CAS  PubMed  Google Scholar 

  15. Thompson LD, Cohen AJ, Edwards FH, Barry MJ. Coronary artery bypass in idiopathic thrombocytopenia without splenectomy. Ann Thorac Surg 1989;48:721–2.

    Article  CAS  PubMed  Google Scholar 

  16. Jubelirer SJ. Coronary artery bypass in two patients with immune thrombocytopenic purpura without preoperative splenectomy. W V Med J 1992;88:510–1.

    CAS  PubMed  Google Scholar 

  17. Sato Y, Ishikawa S, Ootaki A, et al. Concomitant operation of CABG and splenectomy following high-dose transvenous gamma-globulin therapy in a patient with idiopathic thrombocytopenic purpura — a case report [Abstract]. Nippon Kyobu Geka Gakkai Zasshi 1994;42:1222–5.

    CAS  PubMed  Google Scholar 

  18. Hofmeister EP. Coronary artery bypass grafting in chronic immune-mediated thrombocytopenic purpura: preoperative treatment with intravenous immunoglobulin and corticosteroids. Mil Med 1995;160:624–5.

    CAS  PubMed  Google Scholar 

  19. Hayashi S, Eguchi Y, Satou K. Case report of coronary artery bypass grafting using only arterial grafts in a patient with idiopathic thrombocytopenic purpura [Abstract]. Nippon Kyobu Geka Gakkai Zasshi 1996;44:2091–4.

    CAS  PubMed  Google Scholar 

  20. Mathew TC, Vasudevan R, Leb L, et al. Coronary artery bypass grafting in immune thrombocytopenic purpura. Ann Thorac Surg 1997;64:1059–62.

    Article  CAS  PubMed  Google Scholar 

  21. Gotoh H, Fukaya Y, Kohno T, Amano J. Minimally invasive direct coronary artery bypass in a patient with idiopathic thrombocytopenic purpura; report of a reoperative case [Abstract]. Kyobu Geka 2002;55:1049–52.

    CAS  PubMed  Google Scholar 

  22. Ohno H, Higashidate M, Yokosuka T. Washing of the residual solution of cardiopulmonary bypass circuit after coronary artery bypass grafting in idiopathic thrombocytopenic purpura. J Cardiovasc Surg (Torino) 2002;43:185–8.

    CAS  Google Scholar 

  23. Tani M, Takahashi Y, Kobayashi O, et al. Combined surgery of off-pump coronary bypass graft with splenectomy in a patient with refractory immune thrombocytopenic purpura [Abstract]. Masui 2007;56:196–9.

    PubMed  Google Scholar 

  24. Fuchi T, Kondo T, Sase K, Takahashi M. Primary percutaneous transluminal coronary angioplasty performed for acute myocardial infarction in a patient with idiopathic thrombocytopenic purpura. Jpn Circ J 1999;63:133–6.

    Article  CAS  PubMed  Google Scholar 

  25. Caputo RP, Abraham S, Churchill D. Transradial coronary stent placement in a patient with severe idiopathic auto-immune thrombocytopenic purpura. J Invasive Cardiol 2000;12:365–8.

    CAS  PubMed  Google Scholar 

  26. Kikuchi S, Hayashi Y, Fujioka S, et al. A case of intracoronary stent implanted for acute myocardial infarction in an elderly patient with idiopathic thrombocytopenic purpura. Jpn J Geriatr 2002;39:88–93.

    Google Scholar 

  27. Stouffer GA, Hirmerova J, Moll S, et al. Percutaneous coronary intervention in a patient with immune thrombocytopenia purpura. Catheter Cardiovasc Interv 2004;61:364–7.

    Article  PubMed  Google Scholar 

  28. Mendez TC, Diaz O, Enriquez L, et al. Severe thrombocytopenia refractory to platelet transfusions, secondary to abciximab readministration, in a patient previously diagnosed with idiopathic thrombocytopenic purpura. A possible etiopathogenic link. Rev Esp Cardiol 2004;57:789–91.

    Article  PubMed  Google Scholar 

  29. Marques LG, Furukawa MK, Leitão TP, et al. Percutaneous transluminal coronary angioplasty in a patient with idiopathic thrombocytopenic purpura. Arq Bras Cardiol 2005;84:337–9.

    Article  PubMed  Google Scholar 

  30. Fong MC, Chen KC, Leu HB, Chen LC. Coronary revascularization in a patient with immune thrombocytopenic purpura. J Chin Med Assoc 2006;69:436–8.

    Article  PubMed  Google Scholar 

  31. Kim JH, Park KU, Chun WJ, et al. Primary percutaneous coronary intervention for acute myocardial infarction with idiopathic thrombocytopenic purpura: a case report. J Korean Med Sci 2006;21:355–7.

    Article  PubMed  Google Scholar 

  32. Gracia MC, Cebollero IC, Lezcano JS, et al. Invasive treatment performed for acute myocardial infarction in a patient with immune thrombocytopenic purpura. Int J Cardiol 2008;127:e183–5.

    Article  PubMed  Google Scholar 

  33. The Fifth Organization to Assess Strategies in Acute Ischemic Syndromes Investigators. Comparison of fondaparinux and enoxaparin in acute coronary syndromes. N Engl J Med 2006;354:1464–76.

    Article  Google Scholar 

  34. Yusuf S, Mehta SR, Chrolavicius S, et al., OASIS-6 Trial Group. Effects of fondaparinux on mortality and reinfarction in patients with acute ST-segment elevation myocardial infarction: the OASIS-6 randomized trial. JAMA 2006;295:1519–30.

    Article  CAS  PubMed  Google Scholar 

  35. Weitz JI, Buller HR. Direct thrombin onhibitors in acute coronary syndromes: present and future. Circulation 2002;105:1004–11.

    Article  CAS  PubMed  Google Scholar 

  36. Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction — executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction). Circulation 2004;110:588–636.

    Article  PubMed  Google Scholar 

  37. Amit G, Yermiyahu T, Gilutz H, et al. Thrombocytopenia, immunoglobulin treatment, and acute myocardial infarction — a case report. Angiology 2005;56:229–31.

    Article  PubMed  Google Scholar 

  38. Barsheshet A, Marai I, Appel S, Zimlichman E. Acute ST elevation myocardial infarction during intravenous immunoglobulin infusion. Ann N Y Acad Sci 2007;1110:315–8.

    Article  CAS  PubMed  Google Scholar 

  39. Andreou ER, Ledger S. Potential drug interaction between simvastatin and danazol causing rhabdomyolysis. Can J Clin Pharmacol 2003;10:172–4.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiac Catheterization Laboratory, Clinical Hospital Center Zemun, Belgrade University School of Medicine, Belgrade, Serbia

    Aleksandar N. Neskovic MD, PhD, FESC, FACC, Ivan Stankovic, Predrag Milicevic, Aleksandar Aleksic, Alja Vlahovic-Stipac & Biljana Putnikovic

  2. Dedinje Cardiovascular Institute, Belgrade, Serbia

    Branko Calija

  3. Cardiac Catheterization Laboratory, Department of Cardiology, Clinical Hospital Center Zemun, 11080, Belgrade, Serbia

    Aleksandar N. Neskovic MD, PhD, FESC, FACC

Authors
  1. Aleksandar N. Neskovic MD, PhD, FESC, FACC
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ivan Stankovic
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Predrag Milicevic
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Aleksandar Aleksic
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Alja Vlahovic-Stipac
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Branko Calija
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Biljana Putnikovic
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Aleksandar N. Neskovic MD, PhD, FESC, FACC.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Neskovic, A.N., Stankovic, I., Milicevic, P. et al. Primary PCI for Acute Myocardial Infarction in a Patient with Idiopathic Thrombocytopenic Purpura. Herz 35, 43–49 (2010). https://doi.org/10.1007/s00059-010-3262-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00059-010-3262-1

Key Words:

Schlüsselwörter:

Search

Navigation