{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T23:18:20Z","timestamp":1787008700044,"version":"build-2736575974"},"reference-count":8,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2023,1,7]],"date-time":"2023-01-07T00:00:00Z","timestamp":1673049600000},"content-version":"vor","delay-in-days":11,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,12,27]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Glycoprotein (GP) IIb\u2013IIIa inhibitors are antithrombotic drugs used in selected patients during and after percutaneous coronary interventions (PCIs), usually as a bail-out in the setting of no-reflow or thrombotic complications. A notorious life-threatening adverse effect of this drug class is immune-mediated drug-induced thrombocytopenia (DITP). Thrombotic microangiopathy (TMA) induced by GP IIb\u2013IIIa inhibitors has never been reported.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case summary<\/jats:title>\n                    <jats:p>A 72-year-old woman admitted for anterior myocardial infarction treated with primary PCI and stent implantation underwent a first tirofiban infusion as a bail-out strategy. After a new procedure for stent thrombosis, she received a second tirofiban infusion and developed sudden severe thrombocytopenia (platelet count &amp;lt;20\u2005000\/\u00b5L). Tirofiban was stopped but no observed increase in platelet count. Acute kidney injury due to renal ischaemia and left ventricular thrombosis followed. Unexpectedly, evidence for haemolysis and schistocytosis at peripheral blood smear prompted a diagnosis of TMA. Plasma exchange was immediately started with evidence for initial increase in platelet count, but the patient died due to sudden haemodynamic and respiratory deterioration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Tirofiban is known to rarely cause immune-dependent DITP. However, it has never been associated with TMA. This case report not only describes the first case of probable tirofiban-induced TMA, but also highlights the importance of a systematic approach to severe thrombocytopenia, even in the setting of low platelet count from a known DITP-related drug. Treatment of TMA in the difficult context of recent myocardial infarction and stent thrombosis requires a complex interplay between cardiologist, haematologist, transfusionist, and nephrologist, carefully balancing thrombotic and haemorrhagic risk.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytad005","type":"journal-article","created":{"date-parts":[[2023,1,8]],"date-time":"2023-01-08T03:52:30Z","timestamp":1673149950000},"source":"Crossref","is-referenced-by-count":2,"title":["Probable tirofiban-induced thrombotic microangiopathy after stent thrombosis: a case report"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1328-2142","authenticated-orcid":false,"given":"Maria","family":"Mattioli","sequence":"first","affiliation":[{"name":"Unit\u00e0 di Terapia Intensiva Coronarica (UTIC), Cardiology Unit, Parma University Hospital , Parma , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giorgia","family":"Paoli","sequence":"additional","affiliation":[{"name":"Unit\u00e0 di Terapia Intensiva Coronarica (UTIC), Cardiology Unit, Parma University Hospital , Parma , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7091-0438","authenticated-orcid":false,"given":"Benedetta","family":"Camb\u00f2","sequence":"additional","affiliation":[{"name":"Ematologia e CTMO, Parma University Hospital , Parma , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5181-1212","authenticated-orcid":false,"given":"Rosario","family":"Bonura","sequence":"additional","affiliation":[{"name":"Unit\u00e0 di Terapia Intensiva Coronarica (UTIC), Cardiology Unit, Parma University Hospital , Parma , Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,1,7]]},"reference":[{"key":"2023012505350508200_ytad005-B1","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1093\/eurheartj\/ehy394","article-title":"2018 ESC\/EACTS guidelines on myocardial revascularization","volume":"40","author":"Neumann","year":"2019","journal-title":"Eur Heart J"},{"key":"2023012505350508200_ytad005-B2","doi-asserted-by":"crossref","first-page":"2203","DOI":"10.1161\/01.CIR.0000127867.41621.85","article-title":"Thrombocytopenia caused by abciximab or tirofiban and its association with clinical outcome in patients undergoing coronary stenting","volume":"109","author":"Merlini","year":"2004","journal-title":"Circulation"},{"key":"2023012505350508200_ytad005-B3","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1056\/NEJMra1312353","article-title":"Syndromes of thrombotic microangiopathy","volume":"371","author":"George","year":"2014","journal-title":"N Engl J Med"},{"key":"2023012505350508200_ytad005-B4","doi-asserted-by":"crossref","first-page":"1889","DOI":"10.1111\/jth.13764","article-title":"Thrombotic thrombocytopenic purpura: pathogenesis, diagnosis and potential novel therapeutics","volume":"15","author":"Saha","year":"2017","journal-title":"J Thromb Haemost"},{"key":"2023012505350508200_ytad005-B5","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1182\/blood-2014-11-611335","article-title":"Drug-induced thrombotic microangiopathy: a systematic review of published reports","volume":"125","author":"Al-Nouri","year":"2015","journal-title":"Blood"},{"key":"2023012505350508200_ytad005-B6","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1002\/ajh.23960","article-title":"Drug-induced thrombotic microangiopathy: experience of the Oklahoma Registry and the BloodCenter of Wisconsin","volume":"90","author":"Reese","year":"2015","journal-title":"Am J Hematol"},{"key":"2023012505350508200_ytad005-B7","doi-asserted-by":"crossref","first-page":"E241","DOI":"10.1002\/ajh.25208","article-title":"Drug-induced thrombotic microangiopathy: an updated systematic review, 2014\u20132018","volume":"93","author":"Saleem","year":"2018","journal-title":"Am J Hematol"},{"key":"2023012505350508200_ytad005-B8","author":"Platelets on the Web"}],"container-title":["European Heart Journal - Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ehjcr\/advance-article-pdf\/doi\/10.1093\/ehjcr\/ytad005\/48532846\/ytad005.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/7\/1\/ytad005\/48846279\/ytad005.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ehjcr\/article-pdf\/7\/1\/ytad005\/48846279\/ytad005.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,1,25]],"date-time":"2023-01-25T00:35:29Z","timestamp":1674606929000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ehjcr\/article\/doi\/10.1093\/ehjcr\/ytad005\/6974695"}},"subtitle":[],"editor":[{"given":"Ying Xuan","family":"Gue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Christoph Clemens","family":"Kaufmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Diego","family":"Araiza-Garaygordobil","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Emmanouil","family":"Mantzouranis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]},{"given":"Lynsey","family":"Hewitson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,12,27]]},"references-count":8,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12,27]]}},"URL":"https:\/\/doi.org\/10.1093\/ehjcr\/ytad005","relation":{},"ISSN":["2514-2119"],"issn-type":[{"value":"2514-2119","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,1,1]]},"published":{"date-parts":[[2022,12,27]]},"article-number":"ytad005"}}