Partial Reversal of Heparin Anticoagulation by Intravenous Protamine in Abciximab-Treated Patients Undergoing Percutaneous Intervention

Kereiakes, Dean J.; Broderick, Thomas M.; Whang, David D.; Anderson, Laura; Fye, David

doi:10.1016/s0002-9149(97)00437-2

Cited by 31 publications

(5 citation statements)

References 5 publications

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“…20 Although experience is limited, partial reversal of heparin anticoagulation with intravenous protamine in abciximab-treated patients appears to be well tolerated and has successfully reduced in-laboratory ACT values to levels not associated with hemorrhagic risk. 21 In conclusion, the present series characterizes the angiographic profile and clinical course of patients with unplanned coronary stent deployment. The need for unplanned stent placement was reduced by prospective therapy with abciximab and low-dose, weight-adjusted heparin.…”

Section: Discussionmentioning

confidence: 89%

Abciximab Therapy and Unplanned Coronary Stent Deployment

Kereiakes

Lincoff²,

Miller³

et al. 1998

Circulation

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Background-The clinical and angiographic demographics of patients requiring unplanned coronary stent deployment and the optimal adjunct pharmacotherapy in this population are not well described. This report details the EPILOG trial experience with unplanned coronary stent deployment and the effect of abciximab platelet glycoprotein IIb/IIIa blockade to improve clinical outcomes during 6 months of follow-up. Methods and Results-After randomization in the EPILOG double-blind, placebo-controlled trial of abciximab therapy during percutaneous coronary intervention, 326 (12%) of 2792 patients required unplanned coronary stent deployment. Although stented patients were not distinguished by clinical variables, they had greater coronary lesion complexity by American Heart Association/American College of Cardiology criteria (Pϭ.003) and greater incidence of lesion length Ͼ10 mm (Pϭ.002), lesion eccentricity (Pϭ.027), irregular lesion contour (Pϭ.001), and bifurcation involvement (Pϭ.019) than nonstented patients. Unplanned stents were required less often in patients treated with abciximab and low-dose, weight-adjusted heparin than in patients receiving placebo and standard-dose heparin (9.0% versus 13.7%; Pϭ.001). Although adverse clinical outcomes including target-vessel revascularization and bleeding events were more frequent in patients requiring unplanned coronary stent deployment, abciximab therapy reduced adverse outcomes in these patients at 30 days and 6 months to a greater extent than was observed in patients not requiring stent placement. Among stented patients, abciximab therapy did not increase bleeding events. Conclusions-Patients requiring unplanned coronary stent deployment have more complex coronary lesion morphology and a more complicated clinical course after coronary intervention. Abciximab therapy both reduces the need for unplanned stent deployment and confers clinical benefit to patients requiring an unplanned stent, without increasing bleeding complications. (Circulation. 1998;97:857-864.)

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Section: Discussionmentioning

confidence: 89%

Abciximab Therapy and Unplanned Coronary Stent Deployment

Kereiakes

Lincoff²,

Miller³

et al. 1998

Circulation

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“…Furthermore, protamine has been safely administered to facilitate hemostasis following coronary stent deployment without adverse ischemic sequelae [17]. Partial reversal of heparin anticoagulation by protamine in abciximab-treated patients is likewise well tolerated and enhances hemostatic function [18]. In addition, a specific heparinase (Neutralase) has been used to reverse heparin anticoagulation following coronary bypass surgery but its use following PCI or in protamine allergic patients has not been described [19].…”

Section: Reversal Of Procedural Coagulopathymentioning

confidence: 99%

Coronary perforation during percutaneous coronary intervention in the era of abciximab platelet glycoprotein IIb/IIIa blockade: An algorithm for percutaneous management

Dippel

Kereiakes

Tramuta

et al. 2001

Cathet Cardio Intervent

125

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Coronary perforation is an uncommon but potentially life-threatening complication of percutaneous coronary intervention. The use of both atheroablative technologies for coronary intervention and adjunctive platelet glycoprotein blockade pharmacology may increase the incidence of or risk for life-threatening bleeding complications following the occurrence of coronary artery perforation. The interventional database for 6,214 percutaneous coronary interventions performed between January 1995 and June 1999 was analyzed. Hospital charts and cine angiograms for all patients identified in the database as having had coronary perforation were reviewed. Coronary perforation complicated 0.58% of all procedures and was more commonly observed in patients with a history of congestive heart failure and following use of atheroablative interventional technologies (2.8%). There was no association of abciximab therapy with either the incidence of or classification for coronary perforation. Adverse clinical outcomes (death, emergency surgical exploration) were related to the angiographic classification of perforation and were more frequently observed in patients who experienced a class 3 coronary perforation. These data suggest that specific clinical and procedural demographic factors are associated with the occurrence and severity of angiographic coronary perforation. An angiographic perforation class-specific algorithm for treatment of coronary perforation is proposed.

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“…The follow-up period was not specified, however. Kereiakes et al [10] reported on the use of protamine after PCI in 10 patients receiving abcixamab. There were no ischemic outcomes and only one patient had a significant hematoma.…”

Section: Discussionmentioning

confidence: 99%

Immediate protamine administration and sheath removal following percutaneous coronary intervention: A prospective study of 429 patients

Ducas

Chan

Miller

et al. 2002

Cathet Cardio Intervent

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We tested the approach of reversing anticoagulation following PCI and immediate sheath removal in 429 consecutive patients. On completion of the PCI, protamine was administered, and the vascular sheath was immediately removed. Stents were used in 364 patients (85%) and GP IIb/IIIa inhibitors were used in 52 patients (12%). Time to achieve hemostasis was 30 +/- 17 min. Minor groin bleeding occurred in six patients. One patient required repair of femoral pseudoaneurysm. Mean creatine kinase at 8 and 16 hr post-PCI were 129 +/- 35 and 145 +/- 32 units, respectively. Creatine kinase rose to > 3 times normal in 12 out of 350 patients (3.4%). Prior to 48 hr, eight patients (1.9%) required emergency PCI or coronary bypass surgery. Follow-up at 30 days observed no deaths and only three target vessel revascularizations (0.7%). In conclusion, immediate reversal of anticoagulation and sheath removal after PCI is safe and feasible.

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Partial Reversal of Heparin Anticoagulation by Intravenous Protamine in Abciximab-Treated Patients Undergoing Percutaneous Intervention

Cited by 31 publications

References 5 publications

Abciximab Therapy and Unplanned Coronary Stent Deployment

Abciximab Therapy and Unplanned Coronary Stent Deployment

Coronary perforation during percutaneous coronary intervention in the era of abciximab platelet glycoprotein IIb/IIIa blockade: An algorithm for percutaneous management

Immediate protamine administration and sheath removal following percutaneous coronary intervention: A prospective study of 429 patients

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