Last update:
07-Jul-2004

Thrombocytopenia is a common side effect of the drugs presently used in the management of acute coronary syndromes. Heparin mediated immune thrombocytopenia is the most important cause of thrombocytopenia attributable to drugs and, curiously, it is associated with thrombosis. An unusual case is described of a 64 yearold female patient, who manifest severe thrombocytopenia accompanied by hemorrhagic manifestations six days after the initiation of unfractionated heparin and membrane platelet glycoprotein receptor antagonists GPIIb/ IΙΙa combination therapy. Similar findings have been recognized rarely in immune mediated thrombocytopenia related to heparin, but are typical of those observed with use of the glycoprotein inhibitors. Other known causes of thrombocytopenia were excluded and despite the detection of heparin dependent antibodies in her serum, it was considered that in this patient the severe side effect was due to the combined action of both agents. The severity of this complication discouraged hirudin administration and necessitated platelet transfusion. In conclusion, thrombocytopenia due to the effect of combination antithrombotic treatment can create major problems of differential diagnosis. The alertness of the physician in the early recognition of the complication, the appropriate use of combined therapeutic approaches and the immediate decision for treatment, even before laboratory confirmation of the diagnosis, can prevent further progression of the condition, which may otherwise prove lethal.

Key words: Drug induced severe thrombocytopenia, GPIIb/IΙΙa antagonists, Heparin.