SHM Converge Scientific Abstract ePoster Gallery-A Case of a Drug Eluting Stent Placement With Severe Thrombocytopenia

Pdf Summary

This case describes a 69-year-old man with angioimmunoblastic T-cell lymphoma who developed chest pain and was found to have an acute coronary syndrome shortly after autologous stem cell transplant. He had severe chemotherapy-related pancytopenia, including thrombocytopenia with platelets falling to 54 × 10^9/L, along with hypotension, elevated troponins, and ischemic EKG changes.<br /><br />He was treated emergently with aspirin and clopidogrel followed by left heart catheterization. During the procedure he became hemodynamically unstable and required a left ventricular assist device. Coronary angiography showed multivessel coronary artery disease, and drug-eluting stents were placed in the left main, LAD, and proximal circumflex arteries. His ICU course was complicated by cardiogenic shock and worsening thrombocytopenia.<br /><br />A multidisciplinary team debated whether to transfuse platelets to maintain a goal of 50 × 10^9/L so that dual antiplatelet therapy (DAPT) could be continued, versus avoiding platelet transfusion and antiplatelet therapy because of concern for stent thrombosis or bleeding. The team chose to defer both platelet transfusion and antiplatelet therapy initially. As shock resolved and his platelet count improved with stem cell engraftment, DAPT was started 10 days after stent placement without major bleeding or cardiac complications during hospitalization.<br /><br />Repeat coronary angiography three weeks later showed widely patent stents, and he was discharged to rehabilitation. Five months later, however, interruptions in DAPT due to recurrent thrombocytopenia were followed by NSTEMI and significant in-stent restenosis requiring repeat DES placement.<br /><br />The report highlights the uncertainty around optimal antiplatelet management after stenting in patients with severe thrombocytopenia, since the balance between ischemic risk and bleeding risk remains poorly defined.

Asset Subtitle

Hee Korleski

Meta Tag

Author List Hee Korleski

Category Clinical Vignettes

Concept Acute Coronary Syndrome

Concept Thrombocytopenia

Concept Dual Antiplatelet Therapy

Concept Coronary Stent Thrombosis

Concept Cardiogenic Shock

Distinguished Non-Finalist

Presenter Organization Mayo Clinic School of Graduate Medical Education

Presenting Author Hee Korleski

Track Adult

Keywords

angioimmunoblastic T-cell lymphoma

acute coronary syndrome

autologous stem cell transplant

thrombocytopenia

dual antiplatelet therapy

drug-eluting stents

cardiogenic shock

platelet transfusion

in-stent restenosis

coronary angiography

Acute Coronary Syndrome

Thrombocytopenia

Dual Antiplatelet Therapy

Coronary Stent Thrombosis

Cardiogenic Shock