low platelets following heart attack

Hi, I haven't posted in a while and my platelets are holding at 40 thankfully so I have not had to treat my ITP.

I was hoping someone could point me toward some research for my mother in law. She had a heart attack a few weeks ago and she told me that she went in today for bruising and fatigue and found that her platelets were 25. She is on coumadin since the heart attack and her platelets were normal prior to that. Her doctor asked about signs of internal bleeding but didn't think she needed treatment. It sounds like she has an endoscopy and colonoscopy for next week. Can she even do that with her platelets that low?

She said her cardiology appt is not for a few weeks and I asked her to please call them to see if she can get in. She said she'd call them Monday but I"m thinking she should call now to talk about the coumadin.

I'm very concerned about her. I was hoping someone could point me to an article she can read or take to her dr.
Thanks!

Hi Jen, I'm glad you are doing well, and sorry to hear about your mother in law.

The most common cause of drug induced thrombocytopenia purpura - DITP - is heparin, a close cousin to warfarin (coumadin). I cannot find any information on warfarin having the same effect. Could she have been on heparin while she was in the hospital? That is not uncommon. Or is she on some other medication? If it is DITP there is a good chance that her platelets will recover once the offending drug is removed.

Why the endoscopy and colonoscopy now, so soon after her heart attack? The problem with endoscopy with low platelets is not the procedure itself; rather, if any polyps are found they will want to remove them, which can cause bleeding. I do not know the safe levels of platelets for those procedures, but hopefully someone else will chime in.

My platelets had to be at least 50 before I was allowed my endoscopy if that is any help

If your mother-in-law's low platelets are caused by heparin taken at the hospital, the risk of thrombosis is greater than the risk of bleeding (paradoxically). I would be reluctant to have her take measures to increase her platelets, lest she risk thrombosis. Unless there is an immediate need for endoscopy and colonoscopy, I would have her wait until she sees if her platelets will recover on their own.

www.ncbi.nlm.nih.gov/pubmed/21043926
Drug-induced Immune Thrombocytopenia.

SUMMARY. Immune thrombocytopenia is a relatively common problem associated with the clinical usage of drugs. Drugs frequently implicated include quinine, quinidine, heparin, penicillins, cephalosporins, co-trimoxazole, gold and D-penicillamine. Bleeding including bruising and purpura is the usual clinical manifestation except in immune heparin-induced thrombocytopenia in which thrombosis occurs more frequently than bleeding. Cessation of the offending drug is the important step in the treatment but other measures may also be required such as platelet transfusion and steroid therapy for patients with clinical bleeding or antithrombotic therapy with warfarin and dextran or low molecular weight heparin/heparinoid for patients with heparin-induced thrombocytopenia and thrombosis. Idiosyncratic drug-induced thrombocytopenia is mediated by an antibody which binds to platelets only in the presence of the drug resulting in the clearance of sensitised platelets by the reticuloendothelial system. In quinine/quinidine-induced thrombocytopenia, the antibodies recognise drug-dependent epitopes on platelet membrane glycoproteins Ib-IX and/or glycoproteins IIb-IIIa. In immune heparin-induced thrombocytopenia the current data suggest a mechanism which probably involves the binding of heparin-antibody complexes to the platelet Fc receptors but the precise mechanism is yet to be fully characterised. The associated thrombosis in this condition is likely to be due to platelet activation and possibly endothelial cell damage induced by the heparin-related antibody.

Jen:

You might never know what is causing the platelet drop. It can be hard to balance low platelets and blood thinners, but it can be done. There are quite a few people who have had to do that for various reasons. Hopefully she has good doctors who can manage the balance.

Keep us updated.