Hemorragia pulmonar por abciximab: Factores de riesgo y papel de la protamina

Revista Espa de Cardiologia (Impact Factor: 3.34). 04/2005; DOI: 10.1157/13073902
Source: OAI

ABSTRACT Diversos ensayos clínicos han demostrado la eficacia de los inhibidores de la glucoproteína plaquetaria IIb/IIIa en un amplio espectro de pacientes con cardiopatía isquémica. El abciximab, un bloqueador de este receptor, mejora el pronóstico a largo plazo de los pacientes que requieren angioplastia e implante de stent. Los eventos hemorrágicos graves derivados del uso del abciximab son infrecuentes. Comunicamos el caso de una hemorragia pulmonar severa tras el tratamiento con abciximab. Discutimos los factores predisponentes y la administración de protamina en esta complicación potencialmente mortal

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    ABSTRACT: BackgroundCoronary stenting with use of heparin, aspirin, and ticlopidine for thromboprophylaxis is performed in more than 500 000 patients per year worldwide. We did a randomised controlled trial to assess the role of platelet glycoprotein-IIb/IIIa blockade for use in elective stenting.MethodsAt 63 hospitals in the USA and Canada, 2399 patients with ischaemic heart disease and suitable coronary-artery lesions were randomly assigned stenting plus placebo (n=809), stenting plus abciximab, a IIb/IIIa inhibitor (n=794), or balloon angioplasty plus abciximab (n=796). The primary endpoint was a combination of death, myocardial infarction, or need for urgent revascularisation in the first 30 days. All patients received heparin, aspirin, and standard pharmacological therapy.FindingsThe primary endpoint occurred in 87 (10·8%) of 809 patients in the stent plus placebo group, 42 (5·3%) of 794 in the stent plus abciximab group (hazard ratio 0·48 [95% CI 0·33–0.69] p<0·001), and 55 (6·9%) of 796 in the balloon plus abciximab group (0·63 [0·45–0.88] p=0·007). The main outcomes that occurred less with abciximab were death and large myocardial infarction—7·8% in the placebo group, 3·0% for stent plus abciximab (p<0·001), and 4·7% for balloon angioplasty plus abciximab (p=0·01). Major bleeding complications occurred in 2·2% of patients assigned stent plus placebo, 1·5% assigned stent plus abciximab, and 1·4% assigned balloon angioplasty plus abciximab (p=0·38).InterpretationPlatelet glycoprotein-IIb/IIIa blockade with abciximab substantially improves the safety of coronary-stenting procedures. Balloon angioplasty with abciximab is safer than stenting without abciximab.
    The Lancet 07/1998; DOI:10.1016/S0140-6736(98)85010-1 · 39.21 Impact Factor
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    ABSTRACT: Serious hemorrhage and vascular complications after abciximab therapy are associated with elevated activated clotting time values. Our preliminary experience suggests that low-dose intravenous protamine administration is both safe and effective in reducing elevated in-laboratory activated clotting time values and the potential for serious hemorrhage in abciximab-treated patients.
    The American Journal of Cardiology 10/1997; 80(5):633-4. DOI:10.1016/S0002-9149(97)00437-2 · 3.43 Impact Factor
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    ABSTRACT: After coronary stent implantation, antithrombotic therapy is required; however, the specific drug combination to use is still under debate.(1) The ideal regimen should avoid subacute stent thrombosis and hemorrhagic complications and allow an early hospital discharge. The purpose of this study is the evaluation of the safety and efficiency of neutralizing circulating heparin with protamine administration immediately after coronary stent implantation. We hypothesized that the in-laboratory removal of the femoral sheath could reduce groin complications and would shorten the postprocedural period of bed rest and hospital stay after stent implantation. To test this hypothesis, our study compares, in a randomized way, the hospital course of patients with early sheath removal after protamine administration with those in which the femoral sheath was removed after the complete spontaneous disappearance of heparin activity.
    The American Journal of Cardiology 12/1997; 80(10):1336-8. DOI:10.1016/S0002-9149(97)00676-0 · 3.43 Impact Factor


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