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A sticky situation: myocardial infarction in a young woman with immune thrombocytopenia on eltrombopag and a history of mediastinal radiation

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Abstract

More recent immune thrombocytopenia (ITP) treatment strategies enhance platelet production with the use of thrombopoietin receptor agonists (TPO-RA) such as eltrombopag. Patients receiving TPO-RA agents may be at an increased risk of thromboembolism, however the pathophysiology and common underlying risk factors are not well understood. We present the case of a young asplenic woman on eltrombopag for chronic ITP with acute myocardial infarction involving the right coronary artery. Past medical history was significant for remote mediastinal radiation for lymphoma and splenectomy for ITP. She had no other risk factors for coronary artery disease. She underwent coronary catheterization and balloon angioplasty to the culprit lesion, although stenting was deferred due to concerns with dual antiplatelet therapy. She was discharged from hospital on single antiplatelet therapy with acetylsalicylic acid. We believe that the patient’s ITP, recent eltrombopag use, surgical asplenia and history of mediastinal radiation synergistically contributed to her myocardial infarction. The risks of bleeding and thromboembolism must be carefully weighed in patients receiving TPO-RA therapy.

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Acknowledgements

We wish to acknowledge Jessica Petrucci, Michael Garcia and Avery Longmore for their support during manuscript preparation and submission.

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Authors and Affiliations

  1. Department of Medicine, University of Toronto, 190 Elizabeth Street, R. Fraser Elliott Building, 3-805, Toronto, ON, M5G 2C4, Canada

    Jennifer Teichman, Ahmed Taher, Abdulaziz Hashi, Akshay Bagai & Michelle Sholzberg

  2. Terrence Donnelly Heart Centre, St. Michael’s Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada

    Akshay Bagai

  3. Departments of Medicine and Laboratory Medicine & Pathobiology, Li Ka Shing, Knowledge Institute, University of Toronto, 30 Bond Street, Cardinal Carter Wing Room 2-007G, Toronto, ON, M5B 1W8, Canada

    Michelle Sholzberg

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  1. Jennifer Teichman
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  2. Ahmed Taher
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  3. Abdulaziz Hashi
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  4. Akshay Bagai
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  5. Michelle Sholzberg
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Correspondence to Jennifer Teichman.

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Conflict of interest

Dr. Sholzberg has received honoraria and research funding from Amgen and Novartis. We have no other relevant conflicts of interest to declare.

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Teichman, J., Taher, A., Hashi, A. et al. A sticky situation: myocardial infarction in a young woman with immune thrombocytopenia on eltrombopag and a history of mediastinal radiation. J Thromb Thrombolysis 45, 192–195 (2018). https://doi.org/10.1007/s11239-017-1577-y

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  • DOI: https://doi.org/10.1007/s11239-017-1577-y

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