Tirofiban-Induced Severe Thrombocytopenia Following Primary Percutaneous Coronary Intervention: A Case Report

Abstract

Background: Glycoprotein IIb/IIIa inhibitors such as tirofiban are potent intravenous antiplatelet agents used in acute coronary syndromes (ACS), particularly in patients with high thrombus burden undergoing primary percutaneous coronary intervention (PCI). Although highly effective, they can occasionally cause severe, immune-mediated thrombocytopenia, which may be life-threatening if not promptly recognized. Case Presentation: A 43-year-old male with anterior wall ST-elevation myocardial infarction (STEMI) underwent successful primary PCI with thrombus aspiration and drug-eluting stent implantation in the left anterior descending artery. Due to a large thrombus burden, tirofiban was administered as a bolus followed by continuous infusion. Within nine hours, the platelet count dropped from 211 × 10⁹/L to 6 × 10⁹/L, accompanied by ecchymoses but no active bleeding. Comprehensive evaluation excluded heparin-induced thrombocytopenia, disseminated intravascular coagulation, and infection-related causes. A diagnosis of tirofiban-induced thrombocytopenia was established by exclusion. Immediate discontinuation of tirofiban and antiplatelet therapy, followed by intravenous immunoglobulin (IVIG) administration, resulted in a rapid platelet recovery to 43 × 10⁹/L within 24 hours and normalization within three days. The patient was subsequently restarted on clopidogrel monotherapy and rivaroxaban for management of a left ventricular thrombus. Conclusion: This case underscores the importance of early recognition, prompt discontinuation of tirofiban, and multidisciplinary management in treating severe tirofiban-induced thrombocytopenia. Timely intervention and the use of IVIG can be lifesaving and prevent catastrophic bleeding or thrombotic complications.