Acute myocardial infarction induced by avatrombopag: a case report

BackgroundAvatrombopag, a thrombopoietin receptor agonist (TPO-RA), is used for immune thrombocytopenia (ITP) but confers thrombotic risks. Acute myocardial infarction (AMI) as an adverse event is underreported.SummaryA 58-year-old female with steroid-refractory ITP developed ST-elevation myocardial...

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Main Authors: Gou Junqi, Liu Chaohui, Lang Miangjian, Yao Fengyou
Format: Article
Language:English
Published: Frontiers Media S.A. 2025-08-01
Series:Frontiers in Pharmacology
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Online Access:https://www.frontiersin.org/articles/10.3389/fphar.2025.1618693/full
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author Gou Junqi
Liu Chaohui
Lang Miangjian
Yao Fengyou
author_facet Gou Junqi
Liu Chaohui
Lang Miangjian
Yao Fengyou
author_sort Gou Junqi
collection DOAJ
description BackgroundAvatrombopag, a thrombopoietin receptor agonist (TPO-RA), is used for immune thrombocytopenia (ITP) but confers thrombotic risks. Acute myocardial infarction (AMI) as an adverse event is underreported.SummaryA 58-year-old female with steroid-refractory ITP developed ST-elevation myocardial infarction (STEMI) 5 days after initiating avatrombopag monotherapy (20 mg/day). She had no history of traditional cardiovascular risk factors. Her platelet count increased from two to 122 × 109/L before AMI. Coronary angiography revealed thrombotic occlusion of the left ventricular posterior branch, treated with thrombus aspiration. Dual antiplatelet therapy was initiated, and avatrombopag was discontinued. The patient was discharged on day 10 post-AMI. At the 14-day follow-up, thrombocytopenia recurred (platelets 18 × 109/L), requiring avatrombopag re-initiation alongside aspirin. No further thrombosis occurred.ConclusionAvatrombopag monotherapy may induce rapid coronary thrombosis. Prophylactic antiplatelet therapy and maintaining platelets at 50–150 × 109/L are critical during TPO-RA treatment. This case highlights the need for thrombotic risk assessment before TPO-RA initiation.
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spelling doaj-art-2a85d741725642e7a81bc1ea47c9cd122025-08-22T04:10:30ZengFrontiers Media S.A.Frontiers in Pharmacology1663-98122025-08-011610.3389/fphar.2025.16186931618693Acute myocardial infarction induced by avatrombopag: a case reportGou JunqiLiu ChaohuiLang MiangjianYao FengyouBackgroundAvatrombopag, a thrombopoietin receptor agonist (TPO-RA), is used for immune thrombocytopenia (ITP) but confers thrombotic risks. Acute myocardial infarction (AMI) as an adverse event is underreported.SummaryA 58-year-old female with steroid-refractory ITP developed ST-elevation myocardial infarction (STEMI) 5 days after initiating avatrombopag monotherapy (20 mg/day). She had no history of traditional cardiovascular risk factors. Her platelet count increased from two to 122 × 109/L before AMI. Coronary angiography revealed thrombotic occlusion of the left ventricular posterior branch, treated with thrombus aspiration. Dual antiplatelet therapy was initiated, and avatrombopag was discontinued. The patient was discharged on day 10 post-AMI. At the 14-day follow-up, thrombocytopenia recurred (platelets 18 × 109/L), requiring avatrombopag re-initiation alongside aspirin. No further thrombosis occurred.ConclusionAvatrombopag monotherapy may induce rapid coronary thrombosis. Prophylactic antiplatelet therapy and maintaining platelets at 50–150 × 109/L are critical during TPO-RA treatment. This case highlights the need for thrombotic risk assessment before TPO-RA initiation.https://www.frontiersin.org/articles/10.3389/fphar.2025.1618693/fullavatrombopagacute myocardial infarctioncoronary thrombosisimmune thrombocytopeniathrombopoietin receptor agonists
spellingShingle Gou Junqi
Liu Chaohui
Lang Miangjian
Yao Fengyou
Acute myocardial infarction induced by avatrombopag: a case report
Frontiers in Pharmacology
avatrombopag
acute myocardial infarction
coronary thrombosis
immune thrombocytopenia
thrombopoietin receptor agonists
title Acute myocardial infarction induced by avatrombopag: a case report
title_full Acute myocardial infarction induced by avatrombopag: a case report
title_fullStr Acute myocardial infarction induced by avatrombopag: a case report
title_full_unstemmed Acute myocardial infarction induced by avatrombopag: a case report
title_short Acute myocardial infarction induced by avatrombopag: a case report
title_sort acute myocardial infarction induced by avatrombopag a case report
topic avatrombopag
acute myocardial infarction
coronary thrombosis
immune thrombocytopenia
thrombopoietin receptor agonists
url https://www.frontiersin.org/articles/10.3389/fphar.2025.1618693/full
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AT liuchaohui acutemyocardialinfarctioninducedbyavatrombopagacasereport
AT langmiangjian acutemyocardialinfarctioninducedbyavatrombopagacasereport
AT yaofengyou acutemyocardialinfarctioninducedbyavatrombopagacasereport