Successful Primary Stenting in a Patient with Acute STEMI and SevereThrombocytopenia (< 6,000/uL) Due to ITP after IVIG Therapy. (A Case report with Review)

Background: Acute ST-elevation myocardial infarction (STEMI) in patients with chronic immune thrombocytopenic purpura (ITP) and profound thrombocytopenia is extremely rare and poses major therapeutic challenges. The need for urgent reperfusion and antiplatelet therapy conflicts with the high bleeding risk and major vascular access injury, and possible acute instent thrombosis, Reports of successful primary percutaneous coronary intervention (PCI) with platelet counts below 6,000/µL are exceedingly limited. Main Symptoms and Clinical Findings: A 52-year-old male with known chronic ITP, long standing type II DM, and Multi-vessel CAD. presented with acute sever chest pain of 1 hour, dysponea and shock. ECG revealed anterior ST-segment elevation. Platelet count was < 6,000/µL, with otherwise normal coagulation parameters. Diagnoses, Interventions, and Outcomes: A diagnosis of acute anterior STEMI due to LAD occlusion was made. After multidisciplinary evaluation, primary PCI (right radius access) with coronary stenting was performed with I.V Human Gamma Immunoglobulin infusion and full antiplatelet and anticoagulation in PPCI protocol. The procedure was uneventful, and the patient recovered without bleeding or recurrent ischemia. Platelet counts gradually improved with continued ITP therapy. Conclusion : This case demonstrates that primary coronary stenting can be safely achieved even high risk STEMI and Cardiogenic shock with severe thrombocytopenia due to ITP when managed with a coordinated, individualized, and cautious multidisciplinary approach.