Abstract Number: PB1478
Meeting: ISTH 2020 Congress
Background: Patients with GPVI deficiency usually present low or no bleeding tendency suggesting that GPVI might be a promising target for the development of safe antiplatelet agents. However, combining a GPVI deficiency with additional risk factors of bleeding such as thrombocytopenia might worsens the bleeding phenotype.
Aims: We report the use of dual antiplatelet therapy in a patient presenting an acquired GPVI deficiency with no hemorrhagic complication.
Methods: Platelet functions and glycoproteins were analyzed according to standard procedures. Circulating antiGPVI antibodies were detected and purified before testing.
Results: A 64-year-old man was scheduled for inguinal hernia surgery. He reported epistaxis since childhood but no familial history of bleeding. He underwent a first inguinal hernia repair without bleeding 18 years ago. One year later he had hemorrhoids surgery and presented massive postoperative hemorrhage requiring blood transfusion. The origin of bleeding was related to rupture of surgical sutures. Five years later, he presented prominent face and neck hematoma caused by a horse hoof. The patient underwent endovascular vertebrobasilar stenting due to sequalae of this trauma , and received dual antiplatelet therapy (clopidogrel 75 mg/day, aspirin 100 mg/day, 40 days). No bleeding event was recorded during this period. Routine laboratory investigations were normal, apart from an isolated moderate thrombocytopenia (125G/L) with large platelets. Platelet aggregation in response to collagen (2 to 10 µg/mL) and convulxin (800 pM) was very low. A 80% deficiency of the GPVI/FcRgamma chain complex was found on immunoblots and an anti-GPVI antibody was identified. No GPVI gene abnormality was found, but the patient was heterozygous for a mutation in the alpha-actinin gene ACTN1c.682G>A that could account for macrothrombocytopenia.
Conclusions: This is the first report of a patient with an acquired GPVI deficiency who received dual antiplatelet therapy without bleeding. This observation brings new arguments in favor of the safety of therapeutic GPVI antagonists.
To cite this abstract in AMA style:Jandrot-Perrus M, Loyau S, Faille D, Gautier P, Gardiner E, Nurden P, Ajzenberg N. Dual Antiplatelet Therapy in One Patient with a Immune GPVI Deficiency [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/dual-antiplatelet-therapy-in-one-patient-with-a-immune-gpvi-deficiency/. Accessed February 27, 2024.
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