MEDiscuss • Cardiovascular diseases • antiplatelet in IHD

Usually, in IHD patients, we advocate anti-platelet therapy ie aspirin or combination with clopidogrel in high risk patient. Here, i have a simple question. If pt has thrombocytopenia, do he still indicate for antiplatelet? especially those pt with platelet count less than 100,000 ie in myelofibrosis pt, portal HTN pt, ITP pt? any evidence to prove it?

This is a tricky situation. As far as I know there are no recommendations regarding this, but we do face this frequently.

I have an elderly man with a platelet count of 57,000/cumm and significant ischemic heart disease that is not active now. He was on dual anti platelet therapy and I have now stopped the aspirin and continuing only clopidogrel.

Such situations have to be handled in the best way possible by applying the available evidence (not much often) and your experience (not much sometimes). One of those situations where 'clinical wisdom' takes the front seat ahead of 'clinical evidence'.