Primary coronary intervention for acute ST-elevation myocardial infarction in a patient with immune thrombocytopenic purpura

The ideal treatment for a cute myocardial infarction in patients with idiopathic thrombocytopenic purpura (ITP) is not well-known. A 42-year-old male patient with a previous diagnosis of chronic and refractory ITP was admitted with chest pain of four-hour onset. Findings of electrocardiography was consistent with acute anteroseptal myocardial infarction. He had no risk factors for coronary heart disease and was not receiving treatment for ITP, and his platelet count varied between 11,000 and 40,000/mu l before presentation, without any event of bleeding. Transthoracic echocardiography showed hypokinesia of the anterior, middle, and apical segments. Cardiac enzyme levels were elevated and platelet count was 41,000/mu l. Coronary angiography revealed total occlusion of the left anterior descending artery. Primary percutaneous coronary intervention (PCI) was performed, which included predilation and stenting of the lesion. There were no bleeding or ischemic complications during or after PCI and the patient was discharged on the fifth day without any symptoms. He was instructed to take 75 mg clopidogrel daily for two weeks. He was symptom-free at a control visit after this period, with normal left ventricular wall motion on echocardiography.