Dual Anti Platelet Therapy Question

[NormaSaline]

Hi Everyone,

We have a patient with a history of CVA who is on dual anti-platelet therapy, a newer anti-convulsant, and other medications as well. In addition to having several facial openings of sizes from pinprick to half a thumbnail sized, he has in the past complained of coughing up small amounts of blood, but that has now stopped. Basically it appears to me that the blood seems to be very very close to his skin, like I can almost see it. Am I worrying too much about this? Also, his platelets are less than normal, but not mind-freakingly low, but almost in 5 digits, not quite. Is that normal for someone on ASA and plavix?

Norma

[dianah, ASN]

I looked up and skimmed several online articles about DAPT and about platelets specifically, and none suggested lower platelet count is caused by DAPT, and none mentioned lower platelet count being an obstacle to receiving DAPT. It is possible that a patient's platelet count can be affected by DAPT, for each of us is unique in the way we respond to medications. It's good you are aware of what to watch for. Regarding medications being prescribed, always think: benefit VS risk. Does the benefit of this patient being on this medication, outweigh the risk of the patient taking this med?

I have provided some links to articles, just FYI:

https://www.mdedge.com/ccjm/article/161037/importance-platelets-and-platelet-response-acute-coronary-syndromes

https://www.ahajournals.org/doi/pdf/10.1161/01.STR.0000064326.65899.AC

https://www.consultant360.com/articles/clopidogrel-induced-isolated-thrombocytopenia

https://www.ahajournals.org/doi/pdf/10.1161/01.CIR.0000086897.15588.4B

[NormaSaline]

4 hours ago, dianah said:

none suggested lower platelet count is caused by DAPT

Thanks for these! I did see one or two of the same links in my own searching, which I did do, rest assured!

You say that according to the links you list, it is not commonly thought that antiplatelet therapy causes low platelets.

However, from this link, they say it can happen, though it's rare:
https://www.ahajournals.org/doi/pdf/10.1161/01.CIR.0000086897.15588.4B

Quote

In cardiology, the most frequent cause of a low platelet count is an abnormal immune response caused by drug therapy, particularly with the intravenous blood thinner heparin(heparin-induced thrombocytopenia),and rarely with other drugs to control high blood pressure or symptoms of congestive heart failure (diuretics), to control diabetes (antidiabetic medications), or to regulate your blood clotting-(antiplatelet drugs).

Thank you again for the fantastic links.