Tirofiban, a competitive inhibitor of glycoprotein IIb/IIIa receptors on platelet membranes that assist in aggregation, is widely used in high-risk acute coronary syndrome (ACS). We present a case of a 53-year-old man with acute coronary syndrome and triple vessel disease who developed thrombocytopenia after first exposure to tirofiban. He presented to our hospital after his left-sided chest pain had subsided, and he was started on tirofiban 0.15 µg/kg/min; baseline platelets were 264 × 103/µL. Within hours, repeat testing showed a profound fall to 10 × 103/µL, prompting immediate discontinuation of tirofiban, holding aspirin and ticagrelor, hematology consultation, and transfusion of two apheresis platelet units. Platelet counts started to gradually rise back during the following days, and the patient remained free of bleeding complications. On day 3 of admission, dual antiplatelets were restarted as he was considered high risk, and percutaneous coronary intervention (PCI) was carried out successfully on day 4, addressing the right coronary artery (RCA) and left anterior descending artery (LAD). Staged PCI of the remaining vessels was performed two months after discharge without complications. Our patient’s presentation is highly consistent with tirofiban-associated thrombocytopenia, as other alternative causes were deemed unlikely. Early detection, prompt discontinuation, and appropriate supportive care and monitoring are vital to ensure safe recovery and revascularization. Incorporating simple pre-procedure risk stratification, individualizing dosing, and early platelet monitoring may reduce complications while preserving ischemic benefit.

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