acute severe thrombocytopenia occurring after administration of eptifibatide postpones emergent coronary artery surgery

conclusions the authors describe the second reported case of eptifibatide-induced severe thrombocytopenia associated with cardiac surgery. in this case, discontinuation of eptifibatide and transfusion of apheresis platelets increased the platelet count (137 k/ul) the following day, and the patient subsequently underwent successful coronary artery surgery using cardiopulmonary bypass. introduction eptifibatide is a platelet glycoprotein iib/iiia (gp iib/iiia) receptor antagonist that inhibits fibrinogen binding to the activated gp iib/iiia site and prevents platelet-platelet interaction and clot formation. gp iib/iiia inhibitors improve outcome in patients undergoing percutaneous coronary intervention for acute coronary syndrome. thrombocytopenia is a complication of gp iib/iiia inhibitors, but severe thrombocytopenia is unusual. most reported cases of severe thrombocytopenia after eptifibatide occurred in patients with acute coronary syndrome. the authors describe a patient who developed acute profound thrombocytopenia after receiving eptifibatide before emergent coronary artery bypass graft surgery. case presentation a 67-year-old man with a normal platelet count (220 k/ul) developed atrial fibrillation, left bundle branch block, and respiratory insufficiency consistent with acute coronary syndrome two days after colectomy. he received eptifibatide during cardiac catheterization, where three-vessel coronary artery disease was encountered. emergent coronary artery surgery was planned, but the platelet count before surgery was 2 k/ul. eptifibatide was discontinued, surgery was postponed, and acute coronary syndrome was treated with intraaortic balloon counterpulsation.