Acute Thrombocytopenia after Administration of Heparin and Tirofiban: Differential Diagnosis and Treatment

Abstract

Drug-induced thrombocytopenia (DIT) is a condition characterized by low platelet count after administration of a variety of drugs. It is most commonly seen in patients treated with heparin. Its diagnosis is complicated when more than one DIT-causing drug is co-administered. Patients with thrombocytopenia may present with minor or major hemorrhages, depending on the severity of the recess of the platelets. We herein report an uncommon presentation of acute IIb/IIIa glycoprotein inhibitor-induced thrombocytopenia in a 50-year-old male who suffered from myocardial infarction. Serial complete blood counts revealed low platelet counts, rising after discontinuation of the administered IIb/IIIa inhibitor. Recovery was prompt, complete, and sustained with minimal costs. This report highlights the importance of prompt recognition of severe thrombocytopenia caused by IIb/IIIa inhibitors, particularly tirofiban, by measuring platelet count before and after the initiation of tirofiban, as it can be resolved by the interruption of its infusion and early supportive treatment.