Roberto Muniz Ferreira a,b,⇑, João Mansur Filho a, Paolo Blanco Villela a,b, Juliano Carvalho Gomes de Almeida a,b, Pedro Paulo Nogueres Sampaio a, Felipe Neves de Albuquerque a, Wolmar Pulcheri a, Cláudio Buarque Benchimol b a b
Cardiology Department, Samaritano Hospital, Rio de Janeiro, RJ Department of Internal Medicine, Federal University of Rio de Janeiro, Rio de Janeiro, RJ
a,b
Brazil
Contrast-induced thrombocytopenia is a rare complication distinguished by acute and severe platelet consumption, with spontaneous recovery within days. We describe a case of acute thrombocytopenia 6 hours after coronary angioplasty in a patient with a negative antiplatelet factor 4 test. The count reached 1 103/mL, but improved spontaneously to 210 103/mL after 8 days. In conclusion, physicians should be aware of this complication, particularly when dual antiplatelet therapy is being considered. Ó 2017 The Authors. Production and hosting by Elsevier B.V. on behalf of King Saud University. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Keywords: Cardiovascular disease, Contrast media, Thrombocytopenia
Introduction
M
any physicians are not aware of the associa-
tion between contrast exposure and thrombocytopenia because it is a rare event, and therefore very few reports have been published. There is still much to learn about the disease’s clinical characteristics and management, particularly in the context of percutaneous coronary interventions (PCI). Such cases require difficult decision making especially regarding the management of dual antiplatelet therapy, whereas most
previously published case studies described the complication after contrast-based diagnostic tests. Currently, contrast-induced thrombocytopenia has no clinical diagnostic criteria or specific blood test, and therefore it is a presumed diagnosis based on the exclusion of other possibilities, particularly heparin-induced thrombocytopenia (HIT).
Case report A 71-year-old woman with dyslipidemia, active smoking, and progressive angina, despite regular
Disclosure: Authors have nothing to disclose with regard to commercial support. Received 9 January 2017; accepted 22 January 2017.
⇑ Corresponding author at: Samaritano Hospital, Cardiology Department, Rua Bambina 98, Botafogo, Rio de Janeiro, RJ 22251-050, Brazil. E-mail address:
[email protected] (R.M. Ferreira).
P.O. Box 2925 Riyadh – 11461KSA Tel: +966 1 2520088 ext 40151 Fax: +966 1 2520718 Email:
[email protected] URL: www.sha.org.sa
1016–7315 Ó 2017 The Authors. Production and hosting by Elsevier B.V. on behalf of King Saud University. This is an open access article under the CC BYNC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Peer review under responsibility of King Saud University. URL: www.ksu.edu.sa http://dx.doi.org/10.1016/j.jsha.2017.01.002
Production and hosting by Elsevier
Please cite this article in press as: Ferreira R.M. et al., Contrast-induced thrombocytopenia following percutaneous coronary intervention, J Saudi Heart Assoc (2017), http://dx.doi.org/10.1016/j.jsha.2017.01.002
CASE REPORT
Contrast-induced thrombocytopenia following percutaneous coronary intervention
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sions were withheld because of the possibility of HIT. On the next day, the platelet count was unchanged but the partial thromboplastin time had normalized. Antiplatelets remained withdrawn and an antiplatelet factor 4 (antiPF4) assay was ordered to rule out HIT (HemosIL HIT-Ab(PF4H)). As the result was negative (0.1 U/mL; reference
