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Subacute Stent Thrombosis Associated With Prasugrel Refractoriness in a Patient With Chronic ITP
Masahiro Takeo1, Hiroki Okabe1, Keisuke Hidaka1
1The Second Department of Internal Medicine, University of Occupational and Environmental Health, Kitakyusyu, Japan.
Background:
To our knowledge, there have been no reports of stent thrombosis due to prasugrel nonresponse in patients with immune thrombocytopenia (ITP).
Case Summary:
A 66-year-old man with chronic ITP presented with an inferior ST-segment elevation myocardial infarction. The patient underwent drug-eluting stent implantation. On the sixth day, he developed recurrent chest pain. Coronary angiography revealed subacute stent thrombosis. P2Y12 reactive unit (PRU) revealed prasugrel nonresponse (PRU 274), prompting a switch to ticagrelor, which improved PRU (PRU 72). No further stent thrombosis events were observed thereafter.
Discussion:
This case demonstrates that stent thrombosis can occur in patients unresponsive to prasugrel and that PRU measurement may be useful even in ITP patients.
Take-Home Messages:
In ITP patients, it is necessary to carefully balance the risk of thrombosis with the risk of bleeding. Prasugrel nonresponse may contribute to stent thrombosis, and PRU may be useful for identifying prasugrel nonresponse in patients with ITP.
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