Skip to main content
Erschienen in: International Journal of Hematology 3/2012

01.09.2012 | Case Report

Severe thrombocytopenia and alveolar hemorrhage represent two types of bleeding tendency during tirofiban treatment: case report and literature review

verfasst von: Omer Celal Elcioglu, Abdullah Ozkok, Timur Selcuk Akpınar, Fatih Tufan, Murat Sezer, Sabahattin Umman, Sevgi Kalayoglu Besısık

Erschienen in: International Journal of Hematology | Ausgabe 3/2012

Einloggen, um Zugang zu erhalten

Abstract

Tirofiban is a glycoprotein (GP) IIb/IIIa receptor antagonist used in the treatment of acute coronary syndrome (ACS). Thrombocytopenia is a well-known complication of GPIIb/IIIa inhibitors. Life-threatening complications such as alveolar and gastrointestinal system hemorrhages may occur in the course of thrombocytopenia. Platelet count should be monitored closely, including during the first few hours of the infusion. Adverse events may be prevented by prompt discontinuation of the therapy. Herein we present two cases of profound and sudden thrombocytopenia associated with tirofiban use in the treatment of ACS together with a review of the literature.
Literatur
1.
Zurück zum Zitat Karvouni E, Katritsis DG, Ioannidis J. Intravenous glycoprotein IIb/IIIa receptor antagonists reduce mortality after percutaneous coronary interventions. J Am Coll Cardiol. 2003;41:26–32.PubMedCrossRef Karvouni E, Katritsis DG, Ioannidis J. Intravenous glycoprotein IIb/IIIa receptor antagonists reduce mortality after percutaneous coronary interventions. J Am Coll Cardiol. 2003;41:26–32.PubMedCrossRef
2.
Zurück zum Zitat Huxtable LM, Tafreshi MJ, Rakkar ANS. Frequency and management of thrombocytopenia with the glycoprotein IIb/IIIa receptor antagonists. J Am Coll Cardiol. 2006;97:426–9. Huxtable LM, Tafreshi MJ, Rakkar ANS. Frequency and management of thrombocytopenia with the glycoprotein IIb/IIIa receptor antagonists. J Am Coll Cardiol. 2006;97:426–9.
3.
Zurück zum Zitat Labinaz M, Ho C, Banerjee S, Martin J, Chen S, Mensinkai S. Meta-analysis of clinical efficacy and bleeding risk with intravenous glycoprotein IIb/IIIa antagonists for percutaneous coronary intervention. Can J Cardiol. 2007;23(12):963–70.PubMedCrossRef Labinaz M, Ho C, Banerjee S, Martin J, Chen S, Mensinkai S. Meta-analysis of clinical efficacy and bleeding risk with intravenous glycoprotein IIb/IIIa antagonists for percutaneous coronary intervention. Can J Cardiol. 2007;23(12):963–70.PubMedCrossRef
4.
Zurück zum Zitat Kondo K, Umemura K. Clinical pharmacokinetics of tirofiban, a nonpeptide glycoprotein IIb/IIIa receptor antagonist: comparison with the monoclonal antibody abciximab. Clin Pharmacokinet. 2002;41:187–95.PubMedCrossRef Kondo K, Umemura K. Clinical pharmacokinetics of tirofiban, a nonpeptide glycoprotein IIb/IIIa receptor antagonist: comparison with the monoclonal antibody abciximab. Clin Pharmacokinet. 2002;41:187–95.PubMedCrossRef
5.
Zurück zum Zitat The RESTORE Investigators. Effects of platelet glycoprotein IIb/IIIa blockade with tirofiban on adverse cardiac events in patients with unstable angina or acute myocardial infarction undergoing coronary angioplasty. Circulation. 1997;96:1445–53.CrossRef The RESTORE Investigators. Effects of platelet glycoprotein IIb/IIIa blockade with tirofiban on adverse cardiac events in patients with unstable angina or acute myocardial infarction undergoing coronary angioplasty. Circulation. 1997;96:1445–53.CrossRef
6.
Zurück zum Zitat Neumann FJ, Blasini R, Schmitt C, Alt E, Dirschinger J, Gawaz M, Kastrati A, Schömig A. Effects of platelet glycoprotein IIb/IIIa receptor blockade on recovery of coronary flow and left ventricular function after the placement of coronary-artery stents in acute myocardial infarction. Circulation. 1998;98:2695–701.PubMedCrossRef Neumann FJ, Blasini R, Schmitt C, Alt E, Dirschinger J, Gawaz M, Kastrati A, Schömig A. Effects of platelet glycoprotein IIb/IIIa receptor blockade on recovery of coronary flow and left ventricular function after the placement of coronary-artery stents in acute myocardial infarction. Circulation. 1998;98:2695–701.PubMedCrossRef
7.
Zurück zum Zitat The PRISM-PLUS investigators. Glycoprotein IIb/IIIa receptor blockade improves outcomes in diabetic patients presenting with unstable angina/Non-ST-elevation myocardial infarction. Results from the Platelet Receptor Inhibition in Ischemic Syndrome Management in Patient Limited by Unstable Signs and Symptoms (PRISM-PLUS) study. Circulation. 2000;102:2466–72.CrossRef The PRISM-PLUS investigators. Glycoprotein IIb/IIIa receptor blockade improves outcomes in diabetic patients presenting with unstable angina/Non-ST-elevation myocardial infarction. Results from the Platelet Receptor Inhibition in Ischemic Syndrome Management in Patient Limited by Unstable Signs and Symptoms (PRISM-PLUS) study. Circulation. 2000;102:2466–72.CrossRef
8.
Zurück zum Zitat Lee DP, Herity NA, Hiatt BL, Fearon WF, Rezaee M, Carter AJ, Huston M, Schreiber D, DiBatttiste PM, Yeung AC. Adjunctive platelet glycoprotein IIb/IIIa receptor inhibition with tirofiban before primary angioplasty improves angiographic outcomes: results of the TIrofiban Given in the Emergency Room before Primary Angioplasty (TIGER-PA) Pilot Trial. Circulation. 2003;107:1497–501.PubMedCrossRef Lee DP, Herity NA, Hiatt BL, Fearon WF, Rezaee M, Carter AJ, Huston M, Schreiber D, DiBatttiste PM, Yeung AC. Adjunctive platelet glycoprotein IIb/IIIa receptor inhibition with tirofiban before primary angioplasty improves angiographic outcomes: results of the TIrofiban Given in the Emergency Room before Primary Angioplasty (TIGER-PA) Pilot Trial. Circulation. 2003;107:1497–501.PubMedCrossRef
9.
Zurück zum Zitat Topol EJ, Moliterno DJ, Herrmann HC, et al. for the TARGET investigators. 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. 2001;344:1888–94.PubMedCrossRef Topol EJ, Moliterno DJ, Herrmann HC, et al. for the TARGET investigators. 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. 2001;344:1888–94.PubMedCrossRef
10.
Zurück zum Zitat Merlini PA, Rossi M, Menozzi A, Buratti S, Brennan DM, Moliterno DJ, Topol EJ, Ardissino D. Thrombocytopenia caused by abciximab or tirofiban and its association with clinical outcome in patients undergoing coronary stenting. Circulation. 2004;109:2203–6.PubMedCrossRef Merlini PA, Rossi M, Menozzi A, Buratti S, Brennan DM, Moliterno DJ, Topol EJ, Ardissino D. Thrombocytopenia caused by abciximab or tirofiban and its association with clinical outcome in patients undergoing coronary stenting. Circulation. 2004;109:2203–6.PubMedCrossRef
11.
Zurück zum Zitat Ali A, Patil S, Grady KJ, Schreiber TL. Diffuse alveolar hemorrhage following administration of tirofiban or abciximab: a nemesis of platelet glycoprotein IIb/IIIa inhibitors. Catheter Cardiovasc Interv. 2000;49(2):181–4.PubMedCrossRef Ali A, Patil S, Grady KJ, Schreiber TL. Diffuse alveolar hemorrhage following administration of tirofiban or abciximab: a nemesis of platelet glycoprotein IIb/IIIa inhibitors. Catheter Cardiovasc Interv. 2000;49(2):181–4.PubMedCrossRef
12.
Zurück zum Zitat Patel S, Patel M, Din I, Reddy CVR, Kassotis J. Profound thrombocytopenia associated with tirofiban: case report and review of literature. Angiology. 2005;56:351–5.PubMedCrossRef Patel S, Patel M, Din I, Reddy CVR, Kassotis J. Profound thrombocytopenia associated with tirofiban: case report and review of literature. Angiology. 2005;56:351–5.PubMedCrossRef
13.
Zurück zum Zitat Bugie DW, Wilker PR, Wuitschick ED, Curtis BR, Malik M, Levine S, Lind RN, Pereira J, Aster RH. Acute thrombocytopenia after the treatment with tirofiban or eptifibatide is associated with antibodies specific for ligand-occupied GPIIb/IIIa. Blood. 2002;100:2071–6. Bugie DW, Wilker PR, Wuitschick ED, Curtis BR, Malik M, Levine S, Lind RN, Pereira J, Aster RH. Acute thrombocytopenia after the treatment with tirofiban or eptifibatide is associated with antibodies specific for ligand-occupied GPIIb/IIIa. Blood. 2002;100:2071–6.
14.
Zurück zum Zitat Demirkan B, Guray Y, Guray U, Korkmaz S. Differential diagnosis and management of acute profound thrombocytopenia by tirofiban: a case report. J Thromb Thrombolysis. 2006;22:77–8.PubMedCrossRef Demirkan B, Guray Y, Guray U, Korkmaz S. Differential diagnosis and management of acute profound thrombocytopenia by tirofiban: a case report. J Thromb Thrombolysis. 2006;22:77–8.PubMedCrossRef
15.
Zurück zum Zitat Mulot A, Moulin F, Fohlen-Walter A, Angioi M, Sghaier M, Carteaux JP, Lecompte T, de Maistre E. Practical approach to the diagnosis and management of thrombocytopenia associated with tirofiban treatment. Am J Hematol. 2004;77:67–71.PubMedCrossRef Mulot A, Moulin F, Fohlen-Walter A, Angioi M, Sghaier M, Carteaux JP, Lecompte T, de Maistre E. Practical approach to the diagnosis and management of thrombocytopenia associated with tirofiban treatment. Am J Hematol. 2004;77:67–71.PubMedCrossRef
16.
Zurück zum Zitat Eryonucu B, Tuncer M, Erkoc R. Repetitive profound thrombocytopenia after treatment with tirofiban: a case report. Cardiovasc Drugs Ther. 2004;18:503–5.PubMedCrossRef Eryonucu B, Tuncer M, Erkoc R. Repetitive profound thrombocytopenia after treatment with tirofiban: a case report. Cardiovasc Drugs Ther. 2004;18:503–5.PubMedCrossRef
17.
Zurück zum Zitat Dunkley S, Lindeman R, Evans S, Casten R, Jepson N. Evidence of platelet due to tirofiban-dependent platelet antibodies: double trouble. J Thromb Haemost. 2003;1(10):2248–50.PubMedCrossRef Dunkley S, Lindeman R, Evans S, Casten R, Jepson N. Evidence of platelet due to tirofiban-dependent platelet antibodies: double trouble. J Thromb Haemost. 2003;1(10):2248–50.PubMedCrossRef
18.
Zurück zum Zitat George JN, Aster NH. Drug-induced thrombocytopenia: pathogenesis, evaluation, and management. Hematol Am Soc Hematol Educ Program. 2009;1:153–8 (Review). George JN, Aster NH. Drug-induced thrombocytopenia: pathogenesis, evaluation, and management. Hematol Am Soc Hematol Educ Program. 2009;1:153–8 (Review).
19.
20.
Zurück zum Zitat Aster RH, Curtis BR, Bougie DW. Thrombocytopenia resulting from sensitivity to GPIIb-IIIa inhibitors. Semin Thromb Hemost. 2004;30(5):569–77. Review.PubMedCrossRef Aster RH, Curtis BR, Bougie DW. Thrombocytopenia resulting from sensitivity to GPIIb-IIIa inhibitors. Semin Thromb Hemost. 2004;30(5):569–77. Review.PubMedCrossRef
21.
Zurück zum Zitat Billheimer JT, Dicker IB, Wynn R, Bradley JD, Cromley DA, Godonis HE, et al. Evidence that thrombocytopenia observed in humans treated with orally bioavailable glycoprotein IIb/IIIa antagonists is immune mediated. Blood. 2002;99(10):3540–6.PubMedCrossRef Billheimer JT, Dicker IB, Wynn R, Bradley JD, Cromley DA, Godonis HE, et al. Evidence that thrombocytopenia observed in humans treated with orally bioavailable glycoprotein IIb/IIIa antagonists is immune mediated. Blood. 2002;99(10):3540–6.PubMedCrossRef
22.
Zurück zum Zitat George JN, Raskob GE, Shah SR, Rizvi MA, Hamilton SA, Osbome S, Vondracek T. Drug-induced thrombocytopenia: a systematic review of published case reports. Ann Intern Med. 1998;129(11):886–90.PubMed George JN, Raskob GE, Shah SR, Rizvi MA, Hamilton SA, Osbome S, Vondracek T. Drug-induced thrombocytopenia: a systematic review of published case reports. Ann Intern Med. 1998;129(11):886–90.PubMed
23.
Zurück zum Zitat Andres E, Dali-Youcef N, Serraj K, Zimmer J. Recognition and management of drug-induced cytopenias: the example of idisyncratic drug-induced thrombocytopenia. Expert Opin Durg Saf. 2009;8(2):183–90.CrossRef Andres E, Dali-Youcef N, Serraj K, Zimmer J. Recognition and management of drug-induced cytopenias: the example of idisyncratic drug-induced thrombocytopenia. Expert Opin Durg Saf. 2009;8(2):183–90.CrossRef
24.
Zurück zum Zitat Reese JA, Li X, Hauben M, Aster RH, Bougie DW, Curtis BR, George JN, Vesely SK. Identifying drugs that cause acute thrombocytopenia: an analysis using 3 distinct methods. Blood. 2010;116(12):2127–33. Epub 2010 Jun 8.PubMedCrossRef Reese JA, Li X, Hauben M, Aster RH, Bougie DW, Curtis BR, George JN, Vesely SK. Identifying drugs that cause acute thrombocytopenia: an analysis using 3 distinct methods. Blood. 2010;116(12):2127–33. Epub 2010 Jun 8.PubMedCrossRef
25.
Zurück zum Zitat Aster RH. Immune thrombocytopenia caused by glycoprotein IIb/IIIa inhibitors. Chest. 2005;127(2 suppl):53S–9S.PubMedCrossRef Aster RH. Immune thrombocytopenia caused by glycoprotein IIb/IIIa inhibitors. Chest. 2005;127(2 suppl):53S–9S.PubMedCrossRef
26.
27.
Zurück zum Zitat Clofent-Sanchez G, Harizi H, Nurden A, Coste P, Jais C, Nurden P. A case of profound and prolonged tirofiban-induced thrombocytopenia and its correction by intravenous immunoglobulin G. J Thromb Haemost. 2007;5(5):1068–70.PubMedCrossRef Clofent-Sanchez G, Harizi H, Nurden A, Coste P, Jais C, Nurden P. A case of profound and prolonged tirofiban-induced thrombocytopenia and its correction by intravenous immunoglobulin G. J Thromb Haemost. 2007;5(5):1068–70.PubMedCrossRef
28.
Zurück zum Zitat Bosco A, Kidson-Gerber G, Dunkley S. Delayed tirofiban-induced thrombocytopenia: two case reports. J Thromb Haemost. 2005;3(5):1109–10.PubMedCrossRef Bosco A, Kidson-Gerber G, Dunkley S. Delayed tirofiban-induced thrombocytopenia: two case reports. J Thromb Haemost. 2005;3(5):1109–10.PubMedCrossRef
29.
Zurück zum Zitat Said SM, Hahn J, Schleyer E, Müller M, Fiedler GM, Buerke M, Prondzinsky R. Glycoprotein IIb/IIIa receptor inhibitor-induced thrombocytopenia: diagnosis and treatment. Clin Res Cardiol. 2007;96(2):61–9.PubMedCrossRef Said SM, Hahn J, Schleyer E, Müller M, Fiedler GM, Buerke M, Prondzinsky R. Glycoprotein IIb/IIIa receptor inhibitor-induced thrombocytopenia: diagnosis and treatment. Clin Res Cardiol. 2007;96(2):61–9.PubMedCrossRef
30.
Zurück zum Zitat Sakellariou D, Pastromas S, Koulouris S, Manolis AS. First report of tirofiban-induced anemia (found in combination with severe thrombocytopenia). Tex Heart Inst J. 2009;36(1):55–7.PubMed Sakellariou D, Pastromas S, Koulouris S, Manolis AS. First report of tirofiban-induced anemia (found in combination with severe thrombocytopenia). Tex Heart Inst J. 2009;36(1):55–7.PubMed
31.
Zurück zum Zitat Lin YL, Chen LL, Luo YK, Zheng XC, Li WW. Benefit of standard versus low-dose tirofiban for percutaneous coronary intervention in very elderly patients with high-risk acute coronary syndrome. Acta Pharmacol Sin. 2009;30(5):553–8.PubMedCrossRef Lin YL, Chen LL, Luo YK, Zheng XC, Li WW. Benefit of standard versus low-dose tirofiban for percutaneous coronary intervention in very elderly patients with high-risk acute coronary syndrome. Acta Pharmacol Sin. 2009;30(5):553–8.PubMedCrossRef
32.
Zurück zum Zitat Guo J, Xu M, Xi Y. Tirofiban-induced diffuse alveolar hemorrhage: after primary angioplasty. Tex Heart Inst J. 2012;39(1):99–103.PubMed Guo J, Xu M, Xi Y. Tirofiban-induced diffuse alveolar hemorrhage: after primary angioplasty. Tex Heart Inst J. 2012;39(1):99–103.PubMed
33.
Zurück zum Zitat Yilmaz MB, Akin Y, Biyikoglu SF, Guray U, Korkmaz S. Diffuse alveolar hemorrhage following administration of tirofiban in a patient with acute coronary syndrome: a fatal complication. Int J Cardiol. 2004;93(1):81–2.PubMedCrossRef Yilmaz MB, Akin Y, Biyikoglu SF, Guray U, Korkmaz S. Diffuse alveolar hemorrhage following administration of tirofiban in a patient with acute coronary syndrome: a fatal complication. Int J Cardiol. 2004;93(1):81–2.PubMedCrossRef
34.
Zurück zum Zitat Matsuno O, Okubo T, Hiroshige S, Takenaka R, Ono E, Ueno T, et al. Drug-induced lymphocyte stimulation test is not useful for the diagnosis of drug-induced pneumonia. Tohoku J Exp Med. 2007;212(1):49–53.PubMedCrossRef Matsuno O, Okubo T, Hiroshige S, Takenaka R, Ono E, Ueno T, et al. Drug-induced lymphocyte stimulation test is not useful for the diagnosis of drug-induced pneumonia. Tohoku J Exp Med. 2007;212(1):49–53.PubMedCrossRef
35.
Zurück zum Zitat Saito M, Yagi M, Uno K, Takanaka K. Comparative study of the usefulness of the drug-induced lymphocyte stimulation test and the leukocyte migration test in drug allergies. Biol Pharm Bull. 2008;31(2):209–304.CrossRef Saito M, Yagi M, Uno K, Takanaka K. Comparative study of the usefulness of the drug-induced lymphocyte stimulation test and the leukocyte migration test in drug allergies. Biol Pharm Bull. 2008;31(2):209–304.CrossRef
36.
Zurück zum Zitat Huynh T, Piazza N, DiBattiste PM, Snapinn SM, Wan Y, Pharand C, Theroux P. Analysis of bleeding complications associated with glycoprotein IIb/IIIa receptor blockade in patients with high-risk acute coronary syndromes: insights form the PRIM-PLUS study. Int J Cardiol. 2005;100:73–8.PubMedCrossRef Huynh T, Piazza N, DiBattiste PM, Snapinn SM, Wan Y, Pharand C, Theroux P. Analysis of bleeding complications associated with glycoprotein IIb/IIIa receptor blockade in patients with high-risk acute coronary syndromes: insights form the PRIM-PLUS study. Int J Cardiol. 2005;100:73–8.PubMedCrossRef
37.
Zurück zum Zitat 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;140:206–11.PubMedCrossRef 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;140:206–11.PubMedCrossRef
38.
Zurück zum Zitat Tuhta AG, Yeşildağ O, Köprülü D. Tirofiban-associated acute thrombocytopenia. Acta Cardiol. 2006;61(5):577–9.PubMedCrossRef Tuhta AG, Yeşildağ O, Köprülü D. Tirofiban-associated acute thrombocytopenia. Acta Cardiol. 2006;61(5):577–9.PubMedCrossRef
39.
Zurück zum Zitat Rahman N, Jafary FH. Vanishing platelets: rapid and extreme tirofiban-induced thrombocytopenia after percutaneous coronary intervention for acute myocardial infarction. Tex Heart Inst J. 2010;37(1):109–12.PubMed Rahman N, Jafary FH. Vanishing platelets: rapid and extreme tirofiban-induced thrombocytopenia after percutaneous coronary intervention for acute myocardial infarction. Tex Heart Inst J. 2010;37(1):109–12.PubMed
Metadaten
Titel
Severe thrombocytopenia and alveolar hemorrhage represent two types of bleeding tendency during tirofiban treatment: case report and literature review
verfasst von
Omer Celal Elcioglu
Abdullah Ozkok
Timur Selcuk Akpınar
Fatih Tufan
Murat Sezer
Sabahattin Umman
Sevgi Kalayoglu Besısık
Publikationsdatum
01.09.2012
Verlag
Springer Japan
Erschienen in
International Journal of Hematology / Ausgabe 3/2012
Print ISSN: 0925-5710
Elektronische ISSN: 1865-3774
DOI
https://doi.org/10.1007/s12185-012-1133-7

Weitere Artikel der Ausgabe 3/2012

International Journal of Hematology 3/2012 Zur Ausgabe

Erhöhte Mortalität bei postpartalem Brustkrebs

07.05.2024 Mammakarzinom Nachrichten

Auch für Trägerinnen von BRCA-Varianten gilt: Erkranken sie fünf bis zehn Jahre nach der letzten Schwangerschaft an Brustkrebs, ist das Sterberisiko besonders hoch.

Hypertherme Chemotherapie bietet Chance auf Blasenerhalt

07.05.2024 Harnblasenkarzinom Nachrichten

Eine hypertherme intravesikale Chemotherapie mit Mitomycin kann für Patienten mit hochriskantem nicht muskelinvasivem Blasenkrebs eine Alternative zur radikalen Zystektomie darstellen. Kölner Urologen berichten über ihre Erfahrungen.

Ein Drittel der jungen Ärztinnen und Ärzte erwägt abzuwandern

07.05.2024 Medizinstudium Nachrichten

Extreme Arbeitsverdichtung und kaum Supervision: Dr. Andrea Martini, Sprecherin des Bündnisses Junge Ärztinnen und Ärzte (BJÄ) über den Frust des ärztlichen Nachwuchses und die Vorteile des Rucksack-Modells.

Bessere Prognose mit links- statt rechtsseitigem Kolon-Ca.

06.05.2024 Kolonkarzinom Nachrichten

Menschen mit linksseitigem Kolonkarzinom leben im Mittel zweieinhalb Jahre länger als solche mit rechtsseitigem Tumor. Auch aktuell ist das Sterberisiko bei linksseitigen Tumoren US-Daten zufolge etwa um 11% geringer als bei rechtsseitigen.

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.