Table 7.

Factors Favoring or Discouraging Coronary Stent Implantation in Thrombocytopenic Patients^a

In Favor of Coronary Stent Implantation	Against Coronary Stent Implantation
ACS with one or more of the following: • STEMI especially if presenting early after symptom onset • Life-threatening arrhythmias or hemodynamic instability • Proximal coronary stenosis • Stenosis with features of a culprit lesion	Grade 3 or 4 TP
Coronary stenosis at a site supplying large areas of the myocardium potentially leading to hemodynamic instability, such as left main stenosis or last patent open vessel	Anticipated further drop of platelet count or no recovery within the 4 wks following the planned intervention
Coronary stenosis causing cardiogenic shock	Distalcoronary stenosis or stenosis of a side branch
Availability of intravascular imaging ensuring use of adequately sized stents and optimal stent apposition	Complex coronary lesions as defined in the 2020 ESC guidelinesb
	Coronary stenosis without an immediate impact on the clinical course based on the lack of features of a culprit lesion and only borderline significance in a noninvasive stress test or measurement of fractional flow reserve
	Alternative diagnoses explaining cardiac symptoms such as uncontrolled hypertensions or valvular heart disease

^aDefined as patients with existing or anticipated grade 1–4 thrombocytopenia within the following 3 mo.

^bThe 2020 ESC guidelines definition of complex coronary includes but is not limited to the following: coronary stenosis which only can be solved with bifurcation stenting with 2 stents, with very long and small stents, with >3 stents, with >3 stented lesions.¹⁶⁵

ACS = acute coronary syndrome; STEM = ST elevation MI.