{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T05:19:28Z","timestamp":1770959968466,"version":"3.50.1"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100010874","name":"Shandong Provincial Finance Department","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010874","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p>Tirofiban is a glycoprotein (GP) IIb\/IIIa receptor antagonist that inhibits platelet-to-platelet interactions and thrombosis by preventing fibrinogen from binding to platelets. While it has the potential to cause thrombocytopenia and bleeding, instances of severe thrombocytopenia are rare. The question arises whether the concurrent use of tirofiban with other drugs that pose risks to platelets might increase the likelihood of severe platelet depletion. Herein, we present two cases of profound and sudden thrombocytopenia associated with tirofiban use in the treatment of acute progressive stroke. Both patients received ibuprofen for pain relief concomitantly. Drug-induced thrombocytopenia (DITP), a rare but potentially life-threatening adverse effect, occurred. Ibuprofen is a nonsteroidal anti-inflammatory drugs (NSAIDs) with both aspects regarding platelets: function inhibition, responsible for drug-induced thrombocytopenia. We recommend avoiding concomitant use of ibuprofen in patients receiving tirofiban infusion. Alternative analgesics (e.g., acetaminophen\/paracetamol) may be considered when pain management is required. If concurrent administration is unavoidable, intensive platelet count monitoring (e.g., every 6\u201312\u2005h) is imperative during the first 24\u2005h of therapy.<\/jats:p>","DOI":"10.3389\/fcvm.2025.1672200","type":"journal-article","created":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T06:23:07Z","timestamp":1763446987000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Severe thrombocytopenia in the context of concomitant tirofiban and ibuprofen use: does ibuprofen matter?"],"prefix":"10.3389","volume":"12","author":[{"given":"Juxun","family":"Zhu","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chao","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chenlu","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lili","family":"Sun","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,11,18]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"309","DOI":"10.5858\/133.2.309","article-title":"Drug-induced thrombocytopenia","volume":"133","author":"Kenney","year":"2009","journal-title":"Arch Pathol Lab Med"},{"key":"B2","doi-asserted-by":"publisher","first-page":"490","DOI":"10.3109\/09537104.2011.633179","article-title":"Drug-induced immune thrombocytopenia: a descriptive survey in the French PharmacoVigilance database","volume":"23","author":"Moulis","year":"2012","journal-title":"Platelets"},{"key":"B3","doi-asserted-by":"publisher","first-page":"264","DOI":"10.1055\/s-0039-1697930","article-title":"Drug-induced thrombocytopenia: mechanisms and laboratory diagnostics","volume":"46","author":"Danese","year":"2020","journal-title":"Semin Thromb Hemost"},{"key":"B4","doi-asserted-by":"publisher","first-page":"137","DOI":"10.1016\/j.tmrv.2013.05.005","article-title":"Approach to the diagnosis and management of drug-induced immune thrombocytopenia","volume":"27","author":"Arnold","year":"2013","journal-title":"Transfus Med Rev"},{"key":"B5","doi-asserted-by":"publisher","first-page":"586","DOI":"10.1097\/00005344-200304000-00011","article-title":"Abciximab, eptifibatide, and tirofiban exhibit dose-dependent potencies to dissolve platelet aggregates","volume":"41","author":"Moser","year":"2003","journal-title":"J Cardiovasc Pharm"},{"key":"B6","doi-asserted-by":"publisher","first-page":"2350","DOI":"10.1111\/jcpt.13816","article-title":"The efficacy and safety of intravenous tirofiban in the treatment of acute ischemic stroke patients with early neurological deterioration","volume":"47","author":"Du","year":"2022","journal-title":"J Clin Pharm Ther"},{"key":"B7","doi-asserted-by":"publisher","first-page":"29","DOI":"10.2174\/157016108783331303","article-title":"Platelet GPIIb\/IIIa receptor antagonists in human ischemic brain disease","volume":"6","author":"Seitz","year":"2008","journal-title":"Curr Vasc Pharmacol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1161\/01.STR.0000117094.41638.EE","article-title":"Systemic thrombolysis with recombinant tissue plasminogen activator and tirofiban in acute middle cerebral artery occlusion","volume":"35","author":"Straub","year":"2004","journal-title":"Stroke"},{"key":"B9","doi-asserted-by":"publisher","first-page":"e1996","DOI":"10.1212\/WNL.0000000000207194","article-title":"Association of tirofiban with functional outcomes after thrombectomy in acute ischemic stroke due to intracranial atherosclerotic disease","volume":"100","author":"Sang","year":"2023","journal-title":"Neurology"},{"key":"B10","doi-asserted-by":"publisher","first-page":"107702","DOI":"10.1016\/j.clineuro.2023.107702","article-title":"Meta-analysis of the efficacy and safety of tirofiban in patients with acute ischaemic stroke undergoing mechanical thrombectomy","volume":"228","author":"Liu","year":"2023","journal-title":"Clin Neurol Neurosurg"},{"key":"B11","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1002\/ajh.20149","article-title":"Practical approach to the diagnosis and management of thrombocytopenia associated with tirofiban treatment","volume":"77","author":"Mulot","year":"2004","journal-title":"Am J Hematol"},{"key":"B12","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1177\/0218492312445142","article-title":"Tirofiban-induced acute profound thrombocytopenia after primary angioplasty","volume":"21","author":"Dursunoglu","year":"2013","journal-title":"Asian Cardiovasc Thorac Ann"},{"key":"B13","doi-asserted-by":"publisher","first-page":"370","DOI":"10.1007\/s12185-012-1133-7","article-title":"Severe thrombocytopenia and alveolar hemorrhage represent two types of bleeding tendency during tirofiban treatment: case report and literature review","volume":"96","author":"Elcioglu","year":"2012","journal-title":"Int J Hematol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"e14","DOI":"10.1002\/phar.1372","article-title":"Meloxicam-induced thrombocytopenia","volume":"34","author":"Ranieri","year":"2014","journal-title":"Pharmacotherapy"},{"key":"B15","doi-asserted-by":"publisher","first-page":"580","DOI":"10.1056\/NEJMra066469","article-title":"Drug-induced immune thrombocytopenia","volume":"357","author":"Aster","year":"2007","journal-title":"N Engl J Med"},{"key":"B16","first-page":"3","article-title":"Discovery, mechanisms of action and safety of ibuprofen","volume":"135","author":"Rainsford","year":"2003","journal-title":"Int J Clin Pract Suppl"},{"key":"B17","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1007\/s10787-009-0016-x","article-title":"Ibuprofen: pharmacology, efficacy and safety","volume":"17","author":"Rainsford","year":"2009","journal-title":"Inflammopharmacology"},{"key":"B18","doi-asserted-by":"publisher","first-page":"212","DOI":"10.1002\/j.1875-9114.1993.tb02726.x","article-title":"Nonsteroidal antiinflammatory drugs and certain rare, serious adverse events: a cohort study","volume":"13","author":"Jick","year":"1993","journal-title":"Pharmacotherapy"},{"key":"B19","doi-asserted-by":"publisher","first-page":"413","DOI":"10.1007\/BF00186632","article-title":"Immune thrombocytopenia associated with hemorrhagic diathesis due to ibuprofen administration","volume":"71","author":"Meyer","year":"1993","journal-title":"Clin Investig"},{"key":"B20","doi-asserted-by":"publisher","first-page":"e46461","DOI":"10.7759\/cureus.46461","article-title":"Beyond the norm: a case of multiorgan injury triggered by ibuprofen","volume":"15","author":"Medford","year":"2023","journal-title":"Cureus"},{"key":"B21","doi-asserted-by":"publisher","first-page":"169","DOI":"10.1111\/jth.12052","article-title":"A systematic evaluation of laboratory testing for drug-induced immune thrombocytopenia","volume":"11","author":"Arnold","year":"2013","journal-title":"J Thromb Haemost"},{"key":"B22","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1111\/ijcp.12055","article-title":"Ibuprofen: from invention to an OTC therapeutic mainstay","volume":"67","author":"Rainsford","year":"2013","journal-title":"Int J Clin Pract"},{"key":"B23","doi-asserted-by":"publisher","first-page":"979","DOI":"10.1080\/17476348.2021.1951239","article-title":"Ibuprofen and COVID-19 disease: separating the myths from facts","volume":"15","author":"Poutoglidou","year":"2021","journal-title":"Expert Rev Respir Med"},{"key":"B24","doi-asserted-by":"publisher","first-page":"787","DOI":"10.1016\/0090-6980(82)90123-x","article-title":"Indomethacin prevents the long-lasting inhibitory effect of aspirin on human platelet cyclo-oxygenase activity","volume":"23","author":"Livio","year":"1982","journal-title":"Prostaglandins"},{"key":"B25","doi-asserted-by":"publisher","first-page":"383","DOI":"10.1161\/01.atv.3.4.383","article-title":"Ibuprofen protects platelet cyclooxygenase from irreversible inhibition by aspirin","volume":"3","author":"Rao","year":"1983","journal-title":"Arteriosclerosis"},{"key":"B26","doi-asserted-by":"publisher","first-page":"1809","DOI":"10.1056\/NEJMoa003199","article-title":"Cyclooxygenase inhibitors and the antiplatelet effects of aspirin","volume":"345","author":"Catella-Lawson","year":"2001","journal-title":"N Engl J Med"},{"key":"B27","doi-asserted-by":"publisher","first-page":"516","DOI":"10.1111\/j.1365-2796.2010.02299.x","article-title":"Antiplatelet drug interactions","volume":"268","author":"Mackenzie","year":"2010","journal-title":"J Intern Med"},{"key":"B28","doi-asserted-by":"publisher","first-page":"365","DOI":"10.1111\/bjh.14423","article-title":"Guidelines for the use of platelet transfusions","volume":"176","author":"Estcourt","year":"2017","journal-title":"Br J Haematol"},{"key":"B29","doi-asserted-by":"publisher","first-page":"205","DOI":"10.7326\/M14-1589","article-title":"Platelet transfusion: a clinical practice guideline from the AABB","volume":"162","author":"Kaufman","year":"2015","journal-title":"Ann Intern Med"},{"key":"B30","doi-asserted-by":"publisher","first-page":"1177","DOI":"10.3892\/etm.2016.3439","article-title":"Thromboembolic events secondary to tirofiban-induced thrombocytopenia being treated with thrombopoietin: a case report","volume":"12","author":"Li","year":"2016","journal-title":"Exp Ther Med"},{"key":"B31","doi-asserted-by":"publisher","first-page":"966","DOI":"10.1046\/j.1365-2141.2003.04547.x","article-title":"Clinically significant newly presenting autoimmune thrombocytopenic purpura in adults: a prospective study of a population-based cohort of 245 patients","volume":"122","author":"Neylon","year":"2003","journal-title":"Br J Haematol"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1672200\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T06:23:11Z","timestamp":1763446991000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2025.1672200\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,18]]},"references-count":31,"alternative-id":["10.3389\/fcvm.2025.1672200"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2025.1672200","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,18]]},"article-number":"1672200"}}