[A man in his sixties with myocardial infarction, stent thrombosis and haemorrhage]

Area of Science:

• Cardiology
• Oncology
• Hematology

Background:

• A sixty-year-old male presented with acute ST-elevation myocardial infarction, treated with percutaneous coronary intervention (PCI) and antithrombotic medication.
• The patient developed recurrent stent thrombosis, necessitating multiple PCIs and administration of glycoprotein IIb/IIIa-inhibitor abciximab.
• Complicating factors included excessive hematuria and the discovery of urinary bladder cancer, further challenging antithrombotic management.

Observation:

• Following a second administration of abciximab, the patient developed severe, rapid-onset thrombocytopenia (2 x 10^9/L), a rare but known complication.
• This bleeding event occurred shortly after abciximab treatment, raising suspicion for drug-induced thrombocytopenia.

Findings:

• Recurrent stent thrombosis persisted despite multiple PCIs and abciximab treatment.
• Severe thrombocytopenia was identified as a complication of abciximab, particularly after re-administration.
• Aorto-coronary bypass surgery ultimately resolved the recurrent coronary stent thrombosis.

Implications:

• Severe thrombocytopenia should be considered in patients experiencing bleeding during or shortly after abciximab treatment, especially with prior exposure.
• Aorto-coronary bypass surgery is a viable alternative for managing recurrent stent thrombosis when antithrombotic therapy is complicated.
• Patients with a history of severe abciximab-related thrombocytopenia should avoid this medication to prevent recurrence.