Author/Editor		Bombek, Marko; Sinkovič, Andreja
Title		Trombocitopenija pri akutnem koronarnem sindromu s trajnim dvigom veznice ST - prikaz primera in pregled literature
Translated title		Thrombocytopenia in STEMI: a case report and review of literature
Type		članek
Source		Slov Kardiol
Vol. and No.		Letnik 3, št. 1
Publication year		2006
Volume		str. 36-9
Language		slo
Abstract		Reperfusion therapy of acute coronary syndrome with ST-segment elevation in the ECG (STEMI) along with primary percutaneous coronary intervention (PCI) is most efficient and safe in patients with STEMI when combined with various inhibitors of platelet aggregation and heparin. In spite of its efficacy, combined inhibition of platelet aggregation with heparin leads to complications such as thrombocytopenia and bleeding, especially at the puncture site. A case is presented of a patient with STEMI who developed extensive infarction of anterior wall of the left ventricle with Q wave in the ECG. Within the first few hours of treatment, extensive acute bleeding at the puncture site developed due to accompanying thrombocytopenia induced by glycoprotein (GP) receptor inhibitor Ilb/Illa, as demonstrated by exclusion of other causes. When thrombocytopenia regressed, a thrombus developed in the left ventricle in addition to left ventricular heart failure. After several weeks of treatment with low molecular weight heparin, the left ventricular thrombus was successfully removed as demonstrated by echocardiography. Our conclusions are that GP receptor inhibitors Ilb/Illa may induce a severe, but luckily rare and temporary thrombocytopenia with bleeding, which may reoccur on recurrent exposure to the drug.
Summary		Reperfuzijsko zdravljenje akutnega koronarnega sindroma s trajnim dvigom veznice ST v EKG (STEMI) s primarnim perkutanim koronarnim posegom (PCI) je najsodobnejši, najučinkovitejši in najvarnejši način zdravljenja bolnikov s STEMI, zlasti če ga kombinirano z različnimi antiagregacijskimi sredstvi in s heparinom. Kljub učinkovitosti pa lahko zdravljenje s kombinacijo antiagregacijskih sredstev in heparina vodi do zapletov, kot so trombocitopenije in krvavitve, predvsem na vbodnih mestih. Prikazujemo primer bolnice s STEMI, ki je kljub zdravljenju s primarno PCI utrpela obsežen sprednjestenski infarkt srca z zobcem Q v EKG. V prvih urah zdravljenja se je razvila akutna obsežna krvavitev na vbodnem mestu zaradi hude spremljajoče trombocitopenije, ki jo je sprožil zaviralec glikoproteinskih (GP) receptorjev Ilb/Illa, na kar smo sklepali po izključitvi drugih vzrokov. Potrebna je bila transfuzija krvi in trombocitov ter začasna prekinitev antiagregacijskih sredstev in heparina. Po normalizaciji števila trombocitov se je ob popuščanju srca razvil tromb v levem prekatu, ki je po večtedenskem zdravljenju z nizkomolekularnim heparinom izginil, kar je potrdil ultrazvok srca. Zaključimo lahko, da tudi zaviralci GP receptorjev Ilb/Illa sprožijo hude, a na srečo redke in prehodne trombocitopenije s krvavitvami, ki se lahko ponovijo ob ponovni izpostavitvi zdravilu.
Descriptors		MYOCARDIAL INFARCTION THROMBOCYTOPENIA ELECTROCARDIOGRAPHY CORONARY ANGIOGRAPHY HEPARIN, LOW-MOLECULAR-WEIGHT AGED