Liu Yan, Zhang Jingyue, Wang Yantao, Ji Rongxing, Zhang Juanjuan, Yu Xiaodong
Objective To analyze the clinical characteristics of thrombocytopenia induced by eptifibatide. Methods Databases such as CNKI, Wanfang, VIP, PubMed, Web of Science, and Embase as of May 31st, 2020 were searched and case reports on eptifibatide-induced thrombocytopenia were collected. Clinical information including patient′s basic characteristics, eptifibatide application, the occurrence of thrombocytopenia, management and outcomes, etc. were collected and analyzed by descriptive statistical method. Results A total of 30 patients were enrolled in the study, including 17 males and 13 females, aged from 34 to 86 years with an average age of 63 years. Eptifibatide was applied because of percutaneous coronary intervention in 20 patients, acute coronary syndromes in 9 patients, and pre-operative cardiology evaluation in 1 patient. The 29 patients with combined medication records were all treated with heparins, of which 25 received aspirin and 22 received clopidogrel at the same time. The platelet count (PLT) in 30 patients was (129-398)×109/L before eptifibatide treatment and decreased to (<1-78)×109/L after treatment; 1, 2, and 27 cases were with mild, severe, and profound thrombocytopenia, respectively. Time from eptifibatide application to thrombocytopenia occurrence was 1-24-h in 29 patients (≤ 6 h in 21 patients) and 174-h in 1 patient (continuous application for 168-h). Of the 30 patients, 10 had no clinical symptoms, 14 had bleeding symptoms (5 of which were accompanied by decreased hemoglobin), 1 had only decreased hemoglobin, and 5 had other symptoms. Except 1 patient who had stopped eptifibatide 6 hours before thrombocytopenia, the other 29 patients stopped eptifibatide immediately after thrombocytopenia occurrence; 7 patients did not receive any other intervention, 1 patient was treated with glucocorticoid and caffeic acid tablets, and the other 22 patients were treated with platelet infusion and red blood cell infusion, etc. Except 1 patient with no record of time to thrombocytopenia improvement, thrombocytopenia was improved 7 hours to 12 days later in the other 29 patients. Three patients were found to have thrombosis after eptifibatide discontinuation and 1 of them died. Thrombocytopenia recurred in 2 patients after the second application of eptifibatide and was all improved after drug withdrawal and treatments but 1 patient died of septic shock and multiple organ failure finally. Conclusions Eptifibatide might cause severe thrombocytopenia, which usually occurred within 6 hours after application and were without bleeding symptoms sometimes. Thrombocytopenia could be improved if eptifibatide was stopped and platelet transfusion was given according to the patient′s condition.