[Severe tirofiban-induced thrombocytopenia and thrombotic microangiopathy after percutaneous coronary intervention].

HISTORY AND CLINICAL FINDING: A 76-year-old patient suffered a non-ST-elevation myocardial infarction (NSTEMI) and was admitted to our Chest Pain Unit (CPU) for further diagnostics and therapy.

EXAMINATIONS AND DIAGNOSIS: Coronary angiography revealed an occlusion of the right coronary artery and catheter intervention with stent implantation was performed. Due to a high thrombotic burden, application of tirofiban was initiated. In the following, the patient developed hemodynamic instability, hemoptysis and a substantial decrease of the platelet count.

THERAPY AND COURSE: Tirofiban therapy was immediately stopped. Volume therapy led to hemodynamic stabilisationand hemoptysisdisappeared. Thrombocytes normalised after application of a platelet concentrate and prednisolone. One day later, the patient developed pulmonary hemorrhage with asphyxial cardiac arrest.Within the next few days, a renewed decrease of thrombocytes occurred. Despite normalization of thrombocytes after another transfusion, the patient died in consequence of a severe sepsis.

CONCLUSIONS

Thrombocytopenia is a rare but potentially severe complication of tirofiban therapy. Therapeutic strategies include termination of the triggering medication, clarification of differential diagnoses and transfusion of platelet concentrates, if necessary.