Revascularization for patients with idiopathic thrombocytopenic purpura and coronary artery disease

Abstract

Idiopathic thrombocytopenic purpura (ITP) is an autoimmune disorder with a low platelet count characterized by premature platelet destruction and suppression of platelet production mediated by autoantibodies, which may predispose to bleeding. Although the prevalence of coronary artery disease (CAD) in ITP seems to be rare, their co-occurrence is not unusual. Patients with ITP have increased risks for thrombosis and atherosclerosis associated with hemostatic factors, endothelial damage, and the negative effects of steroid and immunoglobulin therapies. Thus, the coexistence of ITP and CAD presents complex problems requiring a balance between hemorrhagic risk and prevention of thrombosis. Here, the authors present two patients with ITP, who were revascularized in different ways for CAD. Although the optimal management of thrombocytopenic patients with CAD is uncertain, individualized treatment modalities can be useful in patients with ITP and CAD.

Keywords: Coronary artery disease; Idiopathic thrombocytopenic purpura; Myocardial revascularization.

Fig. 1

Intracoronary stent implantation in patient 1, who had idiopathic thrombocytopenic purpura. A: coronary angiography in right anterior oblique view shows near total occlusion (arrow) with the Thrombolysis in Myocardial Infarction grade 2 in the proximal left anterior descending coronary artery. B: percutaneous coronary intervention with a drug eluting stent was performed successfully.

Fig. 2

Coronary angiography of patient 2 with idiopathic thrombocytopenic purpura. Coronary angiography in right inferior oblique view (A) and spider view (B) show 60% stenosis in the left main trunk (arrow), total occlusion of the proximal left anterior descending coronary artery with Thrombolysis in Myocardial Infarction grade 0 distal flow (arrowhead).