Intracerebral Hemorrhages Associated With Neurointerventional Procedures Using a Combination of Antithrombotic Agents Including Abciximab

Abstract

Background-We report the occurrence of fatal intracerebral hemorrhage associated with using a combination of antithrombotic agents, including abciximab, in patients undergoing neurointerventional procedures. Summary of Report-Seven patients (average age 60, range 46 to 73 years) developed fatal intracerebral hemorrhages associated with neurointerventional procedures and the use of intravenous abciximab. The procedures included angioplasty and stent placement in the cervical internal carotid artery (nϭ4), angioplasty of the intracranial internal carotid artery (nϭ1), and angioplasty of the middle cerebral artery (nϭ2). Clinical deterioration was observed within 1 hour of the procedure in 5 patients and 7 and 8 hours after the procedure, respectively, in the remaining 2 patients. All patients had received heparin and clopidogrel; 6 had also received aspirin. Key Words: abciximab Ⅲ angioplasty Ⅲ carotid stenosis Ⅲ intracerebral hemorrhage Ⅲ stents A ggressive antithrombotic treatment is used as adjuvant to angioplasty and/or stent placement to reduce the rate of ischemic and thrombotic complications associated with these procedures. Intravenous abciximab, an antibody Fab fragment (c7E3 Fab) directed against platelet IIb/IIIa receptors that inhibit platelet aggregation, has been recently introduced to reduce the rate of ischemic complications associated with angioplasty and atherectomy for atherosclerotic lesions. Intravenously administered abciximab has a short half-life of 10 minutes, but its inhibitory effect on platelets last for 48 hours. 1 The use of abciximab was first evaluated in a prospective, randomized, double-blind trial consisting of 2099 patients undergoing high-risk coronary intervention. 2 Study patients received either a bolus and an infusion of placebo, a bolus of abciximab and an infusion of placebo, or a bolus and an infusion of abciximab. In the group given abciximab alone, ischemic complications of coronary angioplasty and atherectomy were significantly reduced. However, bleeding episodes and transfusions were more frequent in this group. Among all study patients, 6 patients had intracranial hemorrhages. Of these, 2 patients received placebo alone, 1 patient received an abciximab bolus, and 3 patients were assigned to receive the abciximab bolus and infusion (1 of these 3 did not receive the drug because the hemorrhage occurred after randomization but before angioplasty). The beneficial reduction in ischemic complications demonstrated in coronary interventions has led to frequent use of intravenous abciximab as an adjunct to neurointerventional procedures. 3,4 Recent unpublished accounts of intracerebral hemorrhages associated with the use of antithrombotic medications during neurointerventional procedures have prompted us to report our pertinent experience. Conclusions-Intracerebral Subjects and MethodsA report was compiled based on the clinical experience of neurointerventionists at 3 academic medical centers between 1999 and 2000. At each center, patients received intravenous abciximab in a...

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