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Profound drug-induced thrombocytopenia before urgent cardiopulmonary bypass

^a Institute of Anaesthesiology, Triemli City Hospital Zurich, Birmensdorferstrasse 497, 8063 Zurich, Switzerland
^b Division of Cardiology, Department of Internal Medicine, Triemli City Hospital Zurich, 8063 Zurich, Switzerland
^c Division of Cardiac Surgery, Triemli City Hospital Zurich, 8063 Zurich, Switzerland

^* Corresponding author. Tel.: +41-1-466-2209; fax: +41-1-466-2743
christoph.hofer{at}triemli.stzh.ch

A patient with acute coronary syndrome scheduled for urgent coronary artery bypass grafting developed a profound thrombocytopenia during therapy with intravenous heparin and the glycoprotein IIb/IIIa inhibitor tirofiban. Heparin-induced thrombocytopenia and all other possible aetiologies were unlikely and the low platelet count had to be attributed to tirofiban. Anticoagulation during cardiopulmonary bypass was successfully managed with standard heparin. Implications for the diagnosis of coagulation disorders and the management of perioperative anticoagulation are discussed.

Key Words: Thrombocytopenia, drug-related; Glycoprotein IIb/IIIa inhibitor; Heparin, Side effect; Cardiopulmonary bypass