Recurrent acute coronary syndrome and restenosis after percutaneous coronary intervention in a patient with idiopathic thrombocytopenic purpura: a case report and literature reviewReport as inadecuate




Recurrent acute coronary syndrome and restenosis after percutaneous coronary intervention in a patient with idiopathic thrombocytopenic purpura: a case report and literature review - Download this document for free, or read online. Document in PDF available to download.

BMC Cardiovascular Disorders

, 15:101

First Online: 18 September 2015Received: 09 October 2014Accepted: 12 September 2015DOI: 10.1186-s12872-015-0092-3

Cite this article as: Li-Sha, G., Peng, C. & Yue-Chun, L. BMC Cardiovasc Disord 2015 15: 101. doi:10.1186-s12872-015-0092-3

Abstract

BackgroundPlatelets play a pivotal role in the pathogenesis of acute coronary syndrome ACS and acute and chronic complications following percutaneous coronary intervention PCI. Platelet inhibition is a cornerstone in the management of these patients. Idiopathic thrombocytopenic purpura ITP is a bleeding disorder characterized by premature platelet destruction mediated by autoantibodies. The safety of antiplatelet therapy and PCI in patients who have ACS and ITP is unknown. The aim of the present study is to discuss the management strategies for patients who have ACS and ITP and to review limited data available in the literature.

Case presentationWe report the case of a patient with ITP who underwent three separate coronary interventions. The first PCI with stenting was performed in the left anterior descending artery 5 years ago while the patient suffered an anterior acute myocardial infarction, and the platelet count at admission was 90 × 10-L. The patient presented with recurrent ACS and severe in-stent restenosis 5 years after the first PCI, and the platelet count at admission was 18 × 10-L, and elevated to 87 × 10-L after platelets transfusion. He was treated successfully with cutting balloon angioplasty under anticoagulation with unfractionated heparin and antiagregation with acetylsalicylic acid and clopidogrel. Four months later after cutting balloon angioplasty, the patient received an intracoronary stent when he once again presented with recurrent ACS in the setting of restenosis. The patient has been observed for 1.5 years without restenosis after the third PCI.

ConclusionWe reviewed all the cases in the literature involving PCI and discussed the management strategies in patients with ITP and ACS. Available data suggest that PCI can be safe and feasible, and the risk–benefit equation of PCI procedures and antiplatelet therapies should be carefully evaluated, and the treatment should be individualized.

KeywordsAcute coronary syndrome Idiopathic thrombocytopenic purpura Percutaneous coronary intervention Antiplatelet therapy AbbreviationsACSAcute coronary syndrome

ACTActivated clotting time

BMSBare metal stent

DESDrug-eluting stent

GRACEGlobal Registry of Acute Coronary Events

ITPIdiopathic thrombocytopenic purpura

IVIGIntravenous immunoglobulin

LADLeft anterior descending artery

LCXLeft circumflex artery

PCIPercutaneous coronary intervention

RCARight coronary artery

TIMIThrombolysis in Myocardial Infarction

Download fulltext PDF



Author: Ge Li-Sha - Chen Peng - Li Yue-Chun

Source: https://link.springer.com/







Related documents