Thrombocytopenia and Thromboses in Myocardial Infarction Associated with Eptifibatide-Dependent Activating Antiplatelet AntibodiesFunding R.M. was supported by R01HL142809 grant from the National Heart, Lung, and Blood Institute.
01 August 2019
20 April 2020
29 May 2020 (online)
Eptifibitide and other glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitors are commonly used with dual antiplatelet therapy for high-risk percutaneous coronary interventions (PCI) in the treatment of acute coronary syndromes. Although initial clinical trials did not identify a significant incidence of thrombocytopenia following eptifibatide treatment, this complication has become more recognized over time in clinical practice. We report the case of a 60-year-old man with an ST-elevation myocardial infarction (STEMI), who developed profound thrombocytopenia as well as multiple venous and arterial thromboses after exposure to eptifibatide during high-risk PCI. We demonstrate the presence and activity of eptifibatide-dependent anti-platelet antibodies in this patient and present clinical data that supports a causal link between eptifibatide and this patient’s hematologic sequelae.
* Authors contributed equally.
- 1 Dasgupta H, Blankenship JC, Wood GC, Frey CM, Demko SL, Menapace FJ. Thrombocytopenia complicating treatment with intravenous glycoprotein IIb/IIIa receptor inhibitors: a pooled analysis. Am Heart J 2000; 140 (02) 206-211
- 2 Curtis BR, McFarland JG, Wu GG, Visentin GP, Aster RH. Antibodies in sulfonamide-induced immune thrombocytopenia recognize calcium-dependent epitopes on the glycoprotein IIb/IIIa complex. Blood 1994; 84 (01) 176-183
- 3 Sheridan D, Carter C, Kelton JG. A diagnostic test for heparin-induced thrombocytopenia. Blood 1986; 67 (01) 27-30
- 4 Moser M, Bertram U, Peter K, Bode C, Ruef J. Abciximab, eptifibatide, and tirofiban exhibit dose-dependent potencies to dissolve platelet aggregates. J Cardiovasc Pharmacol 2003; 41 (04) 586-592
- 5 Hongo RH, Brent BN. Association of eptifibatide and acute profound thrombocytopenia. Am J Cardiol 2001; 88 (04) 428-431
- 6 Epelman S, Nair D, Downey R, Militello M, Askari AT. Eptifibatide-induced thrombocytopenia and thrombosis. J Thromb Thrombolysis 2006; 22 (02) 151-154
- 7 Gao C, Boylan B, Bougie D. , et al. Eptifibatide-induced thrombocytopenia and thrombosis in humans require FcgammaRIIa and the integrin β3 cytoplasmic domain. J Clin Invest 2009; 119 (03) 504-511
- 8 Giuliano C, Edwin SB, Kador H, Mooney M. Eptifibatide-induced thrombocytopenia and subsequent thrombosis. J Pharm Technol 2012; 28: 146-150
- 9 Tempelhof MW, Benzuly KH, Fintel D, Krichavsky MZ. Eptifibatide-induced thrombocytopenia: with thrombosis and disseminated intravascular coagulation immediately after left main coronary artery percutaneous coronary angioplasty. Tex Heart Inst J 2012; 39 (01) 86-91
- 10 Bougie DW, Wilker PR, Wuitschick ED. , et al. Acute thrombocytopenia after treatment with tirofiban or eptifibatide is associated with antibodies specific for ligand-occupied GPIIb/IIIa. Blood 2002; 100 (06) 2071-2076
- 11 Goel R, Ness PM, Takemoto CM, Krishnamurti L, King KE, Tobian AA. Platelet transfusions in platelet consumptive disorders are associated with arterial thrombosis and in-hospital mortality. Blood 2015; 125 (09) 1470-1476