What would be your approach to percutaneous intervention for acute plaque rupture and cardiogenic shock for a patient with cirrhosis and severe thrombocytopenia?

Thrombocytopenia is not an absolute contraindication to indicated percutaneous coronary intervention (PCI) and the antiplatelet therapy which it obligates.

In a scenario such as this one -- cardiogenic shock complicating an acute myocardial infarction -- PCI is indicated as a life-saving procedure.

This is a risk benefit ratio question and the benefits of PCI far outweigh the bleeding (and paradoxically, thrombotic) risk. ASA and ADP antagonists last the lifespan of the platelet for the most part, so after the early stage of DAPT with ASA and a potent P2Y12 inhibitor, d/c’ing ASA may reduce ov...