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Peer-reviewedCC BY 4.0JACC Case Reports

Managing Acute STEMI in the Setting of Immune Thrombocytopenic Purpura

  • Khaleed Jemmieh1
  • Mohamed Tawengi1
  • Jawaher Baraka1
  • Fathima Mahmood1
  • Fatima Alzahraa Alhaj Akeel2
  • Abdelkarim Alammora3
  • Mhd Ghith Choura3
  1. 1Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar
  2. 2Medical Internship Department, Hamad Medical Corporation, Doha, Qatar
  3. 3Cardiology Department, Hamad Medical Corporation, Doha, Qatar
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Abstract

Background: Immune thrombocytopenia (ITP) is an autoimmune condition characterized by thrombocytopenia. Despite bleeding tendencies, patients with ITP face thrombotic risks. Acute coronary syndrome in ITP is uncommon and poses a management dilemma between antithrombotic therapy and the high bleeding risk.

Case summary: A 43-year-old man with severe ITP (platelet nadir 1 × 103/μL) treated with avatrombopag presented with inferoposterior ST-elevation myocardial infarction (STEMI). Angiography showed occlusion of the right posterolateral ventricular branch and right posterior descending artery. Plain old balloon angioplasty was performed without stenting. He remained stable without bleeding and was discharged on dual antiplatelet therapy, avatrombopag, and prednisolone.

Discussion: ITP presents a clinical paradox of concurrent bleeding and clotting risks. Managing STEMI requires balancing these competing mechanisms.

Take-Home Messages: Thrombocytopenia in ITP does not protect against acute coronary syndrome. Navigating the balance between bleeding and clotting following a STEMI event requires a tailored, flexible approach.

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Cite

BibTeXRIS
BibTeX
@article{jemmieh2026managing,
  title = {{Managing Acute STEMI in the Setting of Immune Thrombocytopenic Purpura}},
  author = {Khaleed Jemmieh and Mohamed Tawengi and Jawaher Baraka and Fathima Mahmood and Fatima Alzahraa Alhaj Akeel and Abdelkarim Alammora and Mhd Ghith Choura},
  journal = {JACC Case Reports},
  year = {2026},
  month = aug,
  doi = {10.1016/j.jaccas.2026.109902},
  url = {https://doi.org/10.1016/j.jaccas.2026.109902},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Managing Acute STEMI in the Setting of Immune Thrombocytopenic Purpura
AU  - Khaleed Jemmieh
AU  - Mohamed Tawengi
AU  - Jawaher Baraka
AU  - Fathima Mahmood
AU  - Fatima Alzahraa Alhaj Akeel
AU  - Abdelkarim Alammora
AU  - Mhd Ghith Choura
PY  - 2026
DA  - 2026/08/19
JO  - JACC Case Reports
DO  - 10.1016/j.jaccas.2026.109902
UR  - https://doi.org/10.1016/j.jaccas.2026.109902
AB  - Background: Immune thrombocytopenia (ITP) is an autoimmune condition characterized by thrombocytopenia. Despite bleeding tendencies, patients with ITP face thrombotic risks. Acute coronary syndrome in ITP is uncommon and poses a management dilemma between antithrombotic therapy and the high bleeding risk.  Case summary: A 43-year-old man with severe ITP (platelet nadir 1 × 103/μL) treated with avatrombopag presented with inferoposterior ST-elevation myocardial infarction (STEMI). Angiography showed occlusion of the right posterolateral ventricular branch and right posterior descending artery. Plain old balloon angioplasty was performed without stenting. He remained stable without bleeding and was discharged on dual antiplatelet therapy, avatrombopag, and prednisolone.  Discussion: ITP presents a clinical paradox of concurrent bleeding and clotting risks. Managing STEMI requires balancing these competing mechanisms.  Take-Home Messages: Thrombocytopenia in ITP does not protect against acute coronary syndrome. Navigating the balance between bleeding and clotting following a STEMI event requires a tailored, flexible approach.
SN  - 2666-0849
ER  -