Severe tirofiban-induced thrombocytopenia following percutaneous coronary intervention

Tirofiban is an intravenous glycoprotein IIb/IIIa inhibitor (GPI) that can be used as a bailout strategy in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) with high thrombus burden. A rare complication of this agent is severe thrombocytopenia, with an incidence ranging from 0.1 % to 0.5 %. We present a case of a patient who presented with ACS, underwent PCI, and subsequently developed severe thrombocytopenia within 24 h of receiving tirofiban. Tirofiban-induced thrombocytopenia is a rare immune-mediated condition that significantly heightens the risk of bleeding complications. Management involves immediate cessation of the drug, close monitoring of platelet counts, and supportive care. Platelet transfusion is indicated when the count falls below 10,000/μL, or below 50,000/μL with significant bleeding. This case highlights the need for early identification with routine platelet checks and close monitoring in patients receiving GPIs to prevent severe adverse outcomes, such as life-threatening bleeding or thrombotic events.

Learning objectives

Severe thrombocytopenia is an exceptionally rare but serious complication of tirofiban. Gaining a comprehensive understanding of the role of tirofiban and other glycoprotein IIb/IIIa inhibitors in the management of acute coronary syndrome, along with recognizing potential complications and accurately differentiating drug-induced thrombocytopenia from other causes, is essential to prevent life-threatening outcomes.