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Eptifibatide-Associated Acute, Profound Thrombocytopenia

Clinical Specialist, Cardiology, Department of Pharmacy, Allegheny General Hospital, Pittsburgh, PA

Robert A Barcelona, PharmD BCPS

at time of writing, Clinical Specialist, Cardiology, Allegheny General Hospital; now, Clinical Pharmacist, The Cleveland Clinic, Cleveland, OH

Tucker Freedy, PharmD BCPS

Clinical Specialist, Drug Information, Allegheny General Hospital

Michael F Hagerty, MD FACC

Cardiologist, Allegheny General Hospital

Reprints: Dr. Coons, Department of Pharmacy, Allegheny General Hospital, 320 E. North Ave., Pittsburgh, PA 15212-4772, fax 412/359-4806, jccst25{at}hotmail.com

OBJECTIVE: To describe 3 cases of eptifibatide-associated acute, profound thrombocytopenia.

CASE SUMMARIES: A 40-year-old black female received eptifibatide 180-µg/kg double bolus followed by a continuous infusion of 2 µg/kg/min for percutaneous coronary intervention (PCI). The platelet count decreased from 308 x 10³/mm³ to 2 x 10³/mm³ 4 hours after initiation of eptifibatide. Eptifibatide was discontinued and platelets were transfused. The patient developed a hematoma and petechiae. A 67-year-old white female received the same dosage regimen of eptifibatide for PCI with no serious adverse effects, with the treatment repeated one month later. At that time, she developed chest and back pain, dyspnea, wheezing, and hypotension after the first bolus. Her platelet count decreased from 334 x 10³/mm³ to 6 x 10³/mm³ 24 hours after initiation. Eptifibatide was discontinued and platelets were transfused. The patient died due to shock. A 72-year-old white male received eptifibatide 180-µg/kg double bolus followed by a continuous infusion of 2 µg/kg/min for acute coronary syndrome. His platelet count decreased from 189 x 10³/mm³ to 17 x 10³/mm³, and eptifibatide was discontinued. Eptifibatide was readministered with bivalirudin for PCI once the platelet count increased to 94 x 10³/mm³. Sixteen hours later, the platelet count decreased to 1 x 10³/mm³. Eptifibatide was discontinued and platelets were transfused. The patient developed a hematoma.

DISCUSSION: Acute, profound thrombocytopenia is a rare complication of glycoprotein IIb/IIIa inhibitor therapy characterized by a precipitous decline in platelet count to <20 x 10³/mm³ within 24 hours of therapy. An objective causality assessment revealed that the adverse drug event was probable in 2 cases and possible in the other.

CONCLUSIONS: Increasing use of the glycoprotein IIb/IIIa inhibitors and enhanced recognition of the potential for acute, profound thrombocytopenia reinforce the need for more vigilant monitoring and alternative management strategies.

Key Words: eptifibatide, thrombocytopenia

Published Online, January 11, 2005. www.theannals.com, DOI 10.1345/aph.1E244

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