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Dengue fever, Thrombocytopenia, STEMI
Dr.Muhammad Farrukh Bhatti, 4 years ago 1 RepliesA patient having PCI to LAD and LCX 15 days ago on dual antiplatlete medications presented with Fever and vomiting from 4 days. Dengue NS-1 via Elisa is positive, His PLT count is in decreasing trend from last 3 days , currently at 45,000.
1- How should we manage this patient having a high risk of stent thrombosis? Should we continue dual antiplatlete , switch to clopidogrel only or totally stop the antiplatlete?
2- if patient starts bleeding is there any role of PLT transfusion? Keeping the recent history of MI?
Best regards.
I think there are no guidelines to answer your question. The clinician and cardiologist should both discuss the situation and decide about the continuation or discontinuation of antiplatelets in such cases.
- It is best to stop dual antiplatelets when the platelet counts drop to less than 50000/ul.
- A single antiplatelet drug, preferably Clopidogrel, may be initiated in patients with platelet counts above 50000/ul.
- Dual antiplatelets can be continued if platelets counts exceed 100000/ul.
- However, in patients who are at high risk of bleeding, all antiplatelets can be discontinued if the platelet counts are less than 100000/ul.
If the patient has minor bleeding, the patient may just be monitored and platelet transfusions should be withheld. In a major bleeding episode, platelets should be transfused regardless of the history of angioplasty, myocardial infarction, or platelet counts.