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

  • [Show abstract] [Hide abstract]
    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; · 39.21 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The use of abciximab, a chimeric monoclonal antibody Fab fragment specific for platelet glycoprotein IIb/IIIa receptors, is associated with improved outcome after angioplasty and stent placement. Major complications include bleeding, but pulmonary hemorrhage has been reported rarely. This study was done to identify patients with pulmonary hemorrhage following abciximab infusion and to define, if possible, any specific risk factors. Retrospective review of institutional coronary angiography and bronchoscopy databases to identify patients who received abciximab and developed pulmonary hemorrhage. Tertiary-care teaching hospital. All patients who underwent coronary angiography and received abciximab between June 1995 and March 2000. None. Measurements and results: Seven of 2,553 patients (0.27%) had documented severe pulmonary hemorrhage associated with chest radiographic abnormalities, impaired oxygenation, and the need for blood product transfusions. The initial symptom was hemoptysis in four of the seven patients. There were two early deaths and one late death. No cases of pulmonary hemorrhage were identified in 5,412 patients who underwent coronary procedures without abciximab infusion. No other risk factors predicting hemorrhage were identified. Severe pulmonary hemorrhage is a complication of abciximab use. Although hemoptysis is an important alerting symptom, it may not be present initially and the diagnosis may be missed or considered late, with the potential for inappropriate treatment until the diagnosis is established. Lesser degrees of bleeding are potentially easily missed, and this report should alert physicians to this complication so that it can be considered early in the evaluation of patients presenting with pulmonary events after abciximab use.
    Chest 08/2001; 120(1):126-31. · 7.13 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The potential for novel antiplatelet and antithrombin agents to contribute to periprocedural bleeding complications of percutaneous coronary revascularization is poorly defined. In the Evaluation of c7E3 Fab in Preventing Ischemic Complications of High-Risk Angioplasty (EPIC) trial, the periprocedural use of aspirin, heparin, and a chimeric antibody to the platelet glycoprotein IIb/IIIa integrin c7E3 Fab in 2099 patients significantly reduced postprocedural ischemic complications and 6-month clinical restenosis but was associated with increased procedural bleeding complications. We review these complications and describe clinical and procedural variables associated with increased bleeding complications in the EPIC trial. Patients with high-risk clinical or lesion morphological characteristics were randomized to receive placebo bolus plus placebo infusion, c7E3 Fab bolus plus placebo infusion, or c7E3 Fab bolus plus c7E3 Fab infusion. Patients received periprocedural aspirin and intravenous heparin continued for a minimum of 12 hours after the procedure. Outcomes reflecting bleeding complications were measured: transfusions, decreased hemoglobin, and an index including both parameters. Major bleeding complications unrelated to bypass surgery occurred in 3.3%, 8.6%, and 10.6%, and blood product transfusions were used in 7.5%, 14.0%, and 16.8% of patients treated with placebo, bolus c7E3 Fab, and bolus plus infusion c7E3 Fab, respectively (both P < .001). Most major bleeding complications occurred at the femoral access site, regardless of treatment. Intracranial hemorrhage (0.3%) and death (0.09%) attributable to major bleeding complications were rare. Multivariable regression analyses identified several variables significantly and independently related to major bleeding complications or greater blood loss, including greater age, female sex, lower weight, c7E3 Fab therapy, and duration and complexity of the index procedure. Major bleeding complications and blood loss in patients receiving bolus plus infusion were not significantly greater than in those receiving bolus alone (P = .38 and P = .14, respectively). Bleeding complications unrelated to bypass surgery were two to three times more frequent in patients receiving c7E3 Fab than in those receiving placebo, but most were transient and well tolerated. Risk-factor analysis and modification of concomitant antithrombotic and antiplatelet treatment strategies may aid in reducing bleeding complications and enhancing clinical benefit in patients receiving c7E3 Fab during percutaneous coronary revascularization.
    Circulation 06/1995; 91(12):2882-90. · 14.95 Impact Factor


Available from