Ocena kliniczna i terapeutyczna pacjentów z ciężką trombocytopenią wywołaną tirofibanem: badanie kohortowe retrospektywne

This study aimed to characterize the clinical features of severe tirofiban-induced thrombocytopenia (TIT) and evaluate the efficacy of immunosuppressive therapy in accelerating platelet recovery. We conducted a retrospective analysis of 29 patients who developed severe thrombocytopenia (platelet count < 50 × 109/L) following tirofiban administration at our hospital between September 2008 and September 2021. Patients were categorized by age (≥60 vs <60 years) and treatment (immunosuppressants: glucocorticoids and/or intravenous immunoglobulin; no immunosuppressants: control). Primary outcomes included platelet recovery time (>100 × 109/L) and bleeding events during thrombocytopenia. Among elderly patients, those receiving immunosuppressive therapy (n = 10) exhibited a significantly shorter platelet recovery time (mean: 3.2 ± 1.1 days) compared to the control group (n = 8, mean: 5.6 ± 1.8 days; P < .05), despite no difference in baseline (82.3 vs 79.6 × 109/L, P = .67) or nadir platelet counts (31.5 vs 28.4 × 109/L, P = .42). In contrast, no such benefit was observed in the nonelderly subgroup. Importantly, no significant differences in major or clinically relevant nonmajor bleeding events were observed between any groups, including in elderly patients receiving immunosuppressive therapy (10.0% vs 12.5%, P > .99). Although severe TIT presents similarly in elderly and nonelderly patients, our findings reveal a distinct age-dependent therapeutic response to immunosuppression. The significantly accelerated platelet recovery observed in elderly patients receiving glucocorticoids and/or intravenous immunoglobulin suggests that immunomodulatory strategies are particularly effective in this population. This differential efficacy may be attributed to immunosenescence, which potentially heightens the susceptibility of older adults to antibody-mediated platelet destruction. Notably, this therapeutic benefit was achieved without increasing the risk of bleeding, addressing a critical concern in anticoagulated patients. These results suggest that age-specific management strategies for severe TIT may be warranted, although validation in larger prospective studies is needed. In elderly patients with severe TIT, immunosuppressive therapy is associated with faster platelet recovery without increasing bleeding risk. These findings support the potential safety and efficacy of immunomodulatory strategies in this population, though validation in larger prospective studies is warranted.