SHM Converge Scientific Abstract ePoster Gallery-Tirofiban-Induced Acute Severe Thrombocytopenia in Patient Undergoing Left Heart Catheterization: Reporting a Rare Adverse Effect

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This case report describes a rare but serious adverse reaction to tirofiban, a glycoprotein IIb/IIIa inhibitor commonly used during left heart catheterization and percutaneous coronary intervention to prevent clot formation.<br /><br />A 50-year-old man with prior lateral and inferior wall myocardial infarctions was admitted with worsening chest pain and shortness of breath. Initial evaluation, including ECG, serial troponins, CBC, and metabolic panel, was unremarkable. On hospital day 3, his symptoms worsened and troponin levels rose, prompting left heart catheterization. The procedure showed 70%–80% in-stent stenosis in the mid-LAD with TIMI-3 flow, and a drug-eluting stent was placed. The patient was then started on a tirofiban infusion.<br /><br />Soon after, he developed hypotension and gum bleeding. Repeat testing showed a dramatic platelet drop from 171,000/µL to 7,000/µL, confirmed on repeat CBC at 8,000/µL. Peripheral smear showed absence of platelets, ruling out pseudothrombocytopenia. Tirofiban was immediately discontinued, and the patient received IV dexamethasone. Platelets began to recover within 6 hours and normalized over several days, reaching 187,000/µL by day 6. Other causes of thrombocytopenia, including HBV, HCV, HIV, and H. pylori infection, were excluded.<br /><br />The report emphasizes that tirofiban-induced acute severe thrombocytopenia can occur rapidly, even within 12 hours of administration, and requires prompt recognition and treatment. Recommended management includes stopping the drug, supportive care, and corticosteroids; platelet or IVIG therapy may be needed in severe cases. The authors also recommend routine platelet monitoring before treatment and at 2 and 6 hours after tirofiban initiation. Patients who experience this reaction should avoid tirofiban permanently.

Asset Subtitle

Jawad Ahmed

Meta Tag

Author List Ankur Singla, Farheen Malik, Gunjan Malhotra, Jawad Ahmed, Kailash Bajaj, Tala Khraise, Tareq Braik

Category Clinical Vignettes

Concept Stable Ischemic Heart Disease

Concept Tirofiban

Concept Tirofiban-Induced Thrombocytopenia

Concept Thrombocytopenia

Concept Left Heart Catheterization

Distinguished Non-Finalist

Presenter Organization Northwest Health Porter

Presenting Author Jawad Ahmed

Track Adult

Keywords

tirofiban

acute thrombocytopenia

glycoprotein IIb/IIIa inhibitor

percutaneous coronary intervention

left heart catheterization

drug-eluting stent

platelet drop

hypotension

corticosteroids

platelet monitoring

Stable Ischemic Heart Disease

Tirofiban

Tirofiban-Induced Thrombocytopenia

Thrombocytopenia

Left Heart Catheterization