Fatal alveolar hemorrhage and Abciximab (ReoProTM) therapy for acute myocardial infarction

Khanlou, Homayoun; Tsiodras, Sotirios; Eiger, Glenn; Abousy, Khalid; Goldberg, Steven K.; Nakhjavan, Fred K.; Yazdanfar, Shahriar

doi:10.1002/(sici)1097-0304(199807)44:3<313::aid-ccd14>3.0.co;2-l

Cited by 16 publications

(19 citation statements)

References 10 publications

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“…68, 127 However, serious and unpredicted bleeding complications, such as alveolar hemorrhage, were also noted later. 128 In Japan, anti-GPIIb/IIIa is not registered because a mid-sized Japan stand-alone trial did not show efficacy, but suggested harm in the abciximab arm. 129 Widespread use of loading-dose clopidogrel therapy reduces the leeway for intravenous antiGPIIb/IIIa agents, even in patients with ACS.…”

Section: Anti-gpiib/iiia Agentsmentioning

confidence: 99%

Platelets: Small in Size But Essential in the Regulation of Vascular Homeostasis　– Translation From Basic Science to Clinical Medicine –

Goto

Hasebe

Takagi

2015

Circ J

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Section: Anti-gpiib/iiia Agentsmentioning

confidence: 99%

Platelets: Small in Size But Essential in the Regulation of Vascular Homeostasis　– Translation From Basic Science to Clinical Medicine –

Goto

Hasebe

Takagi

2015

Circ J

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“…This is because symptoms such as hemoptysis, hypoxemia, and new chest radiological infiltrates are often erroneously attributed to congestive heart failure, acute respiratory distress syndrome, or pulmonary embolism. The fact that hemoptysis can be absent in as many as one-third of all cases of DAH further complicates the diagnosis [6]. Misdiagnosis usually results in inappropriate evaluation and treatment of suspected heart failure, unnecessary use of antibiotics, or even extended exposure to anticoagulation.…”

Section: Discussionmentioning

confidence: 99%

A retrospective analysis and case series of glycoprotein IIb/IIIa inhibitor associated diffuse alveolar hemorrhage: two case reports

Mikkilineni

Bruhl

Colyer

et al. 2009

Cases J

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IntroductionGlycoprotein IIb/IIIa inhibitors have a key role in the treatment of patients with acute coronary syndromes undergoing percutaneous interventions. Although, an increased risk of bleeding complications is well recognized, its association with diffuse alveolar hemorrhage is much less recognized. Previous authors have suggested that the incidence of glycoprotein IIb/IIIa inhibitor associated diffuse alveolar hemorrhage has been significantly underestimated due to under reporting.Case presentationsIn order to help better determine the incidence of GP IIb/IIIa inhibitor associated DAH, a retrospective review of medical records was conducted over a 1 year period at a single high volume medical hospital. The medical records of all patients diagnosed with diffuse alveolar hemorrhage were evaluated for treatment with a GP IIb/IIIa inhibitor within 48 hours of its diagnosis. Each patient meeting the inclusion and exclusion criteria were included in the case series. This number was compared with the total number of patients receiving a GP IIb/IIIa inhibitor during the same time period and an incidence of the complication was calculated.292 patients received either abciximab or eptifibatide during the one year review period and two patients were diagnosed with diffuse alveolar hemorrhage confirmed by serial bronchiolar lavage for an incidence of 0.68%. Of the total 292 patients receiving GP IIb/IIIa inhibitors, 172 patients received abciximab with one occurrence of diffuse alveolar hemorrhage for an incidence of 0.58% while 120 patients received eptifibatide with one occurrence for an incidence of 0.83%. Both patients developed significant morbidity as a result of the complication and 1 of the 2 patients died as a complication of the disease.ConclusionsOur findings support the claim that the incidence of GP IIb/IIIa induced diffuse alveolar hemorrhage is substantially higher than initially suggested by drug manufacturer studies. Although these drugs have proven mortality benefits, its association with diffuse alveolar hemorrhage is likely under-recognized leading to significant under-reporting. The best way to more accurately determine the true incidence of this complication and decrease its morbidity and mortality is to increase awareness as well as include diffuse alveolar hemorrhage as a serious complication in product labeling.

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“…Kanlou et al [10] report six additional cases of abciximab-induced PAH. Only one case of alveolar bleeding has been reported in patient receiving eptifibatide.…”

Section: Discussionmentioning

confidence: 99%

“…Pulmonary alveolar haemorrhage (PAH) is a serious but rare life-threatening complication [6][7][8][9][10][11].…”

Section: Preliminar Diagnosismentioning

confidence: 99%

A case report of alveolar haemorrhage associated with severe thrombocytopenia induced by abciximab infusion in a patient with an acute coronary syndrome

et al. 2008

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PresentationDr. Vizzardi: We describe the case of a man, 55 years old, who was admitted to our Intensive Coronary Unit for severe chest pain. The past history included smoking and hypertension, while there was a family history of coronary artery disease.At the time of admission the blood pressure was 120/ 60 mmHg and the heart rate was 78 beats per minute. The electrocardiogram showed ST segment elevation in the anterior leads, and a transthoracic echocardiogram (TTE) revealed anterior septal and anterior wall akinesis with a severe systolic dysfunction (ejection fraction of 30%).After treatment with aspirin, beta-blockers, nitrates and heparin plus a bolus and continuous infusion of abciximab, the patient underwent coronary angiography showing total occlusion of the left anterior coronary artery. A successful angioplasty was performed. In order to reduce the risk of acute thrombotic reocclusion of the culprit artery, abciximab infusion was continued. After 6 h, the patient developed severe dyspnea and tachypnea. The pulse oximetry revealed a severe oxygen desaturation of 88% with 100% FiO 2 , Laboratory tests showed severe thrombocytopenia (platelets 5,000 mm 3 ) and a significant drop in hemoglobin levels (3.1 g/dl). A Chest radiograph revealed new bilateral diffuse lung opacities infiltrates (Fig. 1).The anticoagulation therapy was stopped immediately, and the patient was transfused with platelets and packed red blood cells. We observed a rapid improvement in the platelet count and hemoglobin values (respectively of 145,000/mm 3 and 13 g/dl). The erythrocyte sedimentation rate and others autoimmune serology tests were negative. The Chest X-ray studies showed a progressive and complete resolution of the alveolar infiltrates; therefore after ten days clopidogrel (75 mg/die) and aspirin (100 mg/die) were restarted.Before discharge, a TTE revealed only moderate left ventricular systolic dysfunction (EF 45%). Preliminar diagnosisDr. D'Aloia, Dr. Zanini, Dr. Antonioli: The use of abciximab, a chimeric monoclonal antibody Fab fragment specific for platelet glycoprotein IIb/IIIa receptors, in patients presenting with acute ischemic coronary syndromes, is associated with improved outcome after percutaneous coronary angioplasty (PTCA) and stent placement [1-4] but complications include major hemorrhage with anaemia and thrombocytopenia [2][3][4][5].Bleeding can occur in the presence or absence of thrombocytopenia varying from mild to severe, and usually occurring within 24 h after initial exposure to the drug [5]. Pulmonary alveolar haemorrhage (PAH) is a serious but rare life-threatening complication [6][7][8][9][10][11].

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Fatal alveolar hemorrhage and Abciximab (ReoProTM) therapy for acute myocardial infarction

Cited by 16 publications

References 10 publications

Platelets: Small in Size But Essential in the Regulation of Vascular Homeostasis　– Translation From Basic Science to Clinical Medicine –

Platelets: Small in Size But Essential in the Regulation of Vascular Homeostasis　– Translation From Basic Science to Clinical Medicine –

A retrospective analysis and case series of glycoprotein IIb/IIIa inhibitor associated diffuse alveolar hemorrhage: two case reports

A case report of alveolar haemorrhage associated with severe thrombocytopenia induced by abciximab infusion in a patient with an acute coronary syndrome

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Fatal alveolar hemorrhage and Abciximab (ReoProTM) therapy for acute myocardial infarction

Cited by 16 publications

References 10 publications

Platelets: Small in Size But Essential in the Regulation of Vascular Homeostasis – Translation From Basic Science to Clinical Medicine –

Platelets: Small in Size But Essential in the Regulation of Vascular Homeostasis – Translation From Basic Science to Clinical Medicine –

A retrospective analysis and case series of glycoprotein IIb/IIIa inhibitor associated diffuse alveolar hemorrhage: two case reports

A case report of alveolar haemorrhage associated with severe thrombocytopenia induced by abciximab infusion in a patient with an acute coronary syndrome

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Platelets: Small in Size But Essential in the Regulation of Vascular Homeostasis　– Translation From Basic Science to Clinical Medicine –

Platelets: Small in Size But Essential in the Regulation of Vascular Homeostasis　– Translation From Basic Science to Clinical Medicine –