Acute profound thrombocytopenia associated with glycoprotein IIb/IIIa receptor inhibitor after percutaneous coronary intervention: a single-center 6-year case series and therapy insights

Acute profound thrombocytopenia is a rare, yet potentially life-threatening complication associated with intravenous glycoprotein IIb/IIIa receptor inhibitors (GPI), which are widely used in the management of acute coronary syndrome and during percutaneous coronary intervention (PCI). Treatments with steroids and intravenous immunoglobulin (IVIg) are recommended for GPI-induced thrombocytopenia; however, evidence regarding their efficacy remains limited. In this retrospective study, 21 patients who developed acute profound thrombocytopenia (defined as a platelet count < 20 × 10 9 /L) following PCI and GPI treatment were enrolled. Patients’ clinical characteristics, the timing of detection of thrombocytopenia, the administration of steroids and IVIg therapy, and subsequent changes in platelet counts and clinical outcomes were analyzed. Among the 21 patients, 7 were females, and the median age was 63 years. Tirofiban and eptifibatide were administered to 12 and 9 patients, respectively. Thrombocytopenia was detected on the day of PCI in 9 patients. Among the remaining 12 patients, one was found to have a profound decline in platelets only after the onset of intracerebral hemorrhage and coma, whereas the other 11 patients were diagnosed during routine blood testing on the first day after PCI. The median nadir platelet count was 4 × 10 9 /L among all patients. 11 patients received both steroids and IVIg, 6 received steroids alone, and 4 did not receive any intervention. To evaluate the potential effect of steroids and IVIg therapy on platelet recovery, patients were categorized into three treatment groups: Steroids plus IVIg, steroids alone, and no intervention. No statistical difference was observed among the treatment groups. A separate analysis was performed by categorizing patients according to whether thrombocytopenia was detected on the day of PCI (early detection group) or on the first day after PCI (late detection group). Patients with early diagnosis who underwent prompt GPI withdrawal demonstrated significantly faster platelet recovery. The median time to platelet recovery above 20 × 10 9 /L was significantly shorter in the early detection group (24 h) than in the late detection group (72 h), with a p -value of 0.017. GPI-induced thrombocytopenia progresses rapidly following GPI exposure and is marked by an abrupt onset. Timely detection of thrombocytopenia and prompt GPI withdrawal are critical for platelet recovery. In our study, neither steroids nor IVIg improved platelet recovery.