Thrombolytic therapy in a patient with thrombocytopenia

A middle aged man was admitted to the hospital with dengue fever. He had a low platelet count of 60,000/cu.mm on admission. In the ward he developed chest pain and an acute anterior wall ST elevation myocardial infarction. The specialist in charge of the patient decided to administer Streptokinase believing that salvaging the ischemic myocardium outweighed the risk of bleeding. The patient had no bleeding complications from the Streptokinase even though his platelet count continued to fall to a level of 20000/cu.mm over the next few days.

This made me wonder if it was safe to administer thrombolytic therapy to people with pre-existing thrombocytopenia.

The evidence I found in the literature says that, if patients have no bleeding manifestations, it is relatively safe to administer thrombolytic therapy. Heparin, because of its potential to reduce platelet counts, may be more dangerous than Streptokinase. Even though this patient that I described above did not suffer any bleeding complications from thrombolysis, my intuitive feeling is that it is prudent to transfuse platelets if the platelet count is very low when thrombolytic therapy is contemplated.

Reference: An editorial in Clinical Cardiology