Thrombocytopenia Caused by Abciximab or Tirofiban and Its Association With Clinical Outcome in Patients Undergoing Coronary Stenting

Abstract

Background-Thrombocytopenia is a possible complication of treatment with glycoprotein (GP) IIb/IIIa antagonists during percutaneous coronary interventions, but it is not clear whether different GP IIb/IIIa inhibitors carry a different risk of thrombocytopenia, and its relation to clinical outcome is unknown. Methods and Results-We analyzed data from the Do Tirofiban and Reopro Give Similar Efficacy Outcomes (TARGET) study, which compared the safety and efficacy of abciximab and tirofiban in patients undergoing coronary stenting. Platelets were measured at baseline and 6 and 24 hours after the beginning of treatment. Thrombocytopenia (nadir platelet count Ͻ100ϫ10 9 cells/L) developed in 2.4% of patients treated with abciximab and 0.5% of those treated with tirofiban (PϽ0.001). The variables independently associated with thrombocytopenia were treatment with abciximab within the previous 6 months (OR, 4.4; 95% CI, 1.7 to 11.2), baseline creatinine levels of Ն0.8 mg/dL (OR, 3.8; 95% CI, 1.7 to 8.8), previous transient ischemic attack (OR, 3.2; 95% CI, 1.4 to 7.6), female gender (OR, 1.9; 95% CI, 1.2 to 3.1), and history of peripheral vascular disease (OR, 1.78; 95% CI, 1.0 to 3.1). Severe bleeding occurred more frequently in patients with thrombocytopenia (5.1% versus 0.7%, Pϭ0.001), who also more frequently received blood transfusions (6.1% versus 1.4%, Pϭ0.001). At the 30-day follow-up, 2.0% of patients with thrombocytopenia and 0.4% of those without (Pϭ0.022) had died; myocardial infarction occurred in 9.13% versus 6.11% (PϭNS); and target vessel revascularization occurred in 6.07% versus 0.60% (PϽ0.001). Conclusions-During coronary stenting, abciximab and other risk factors are independently associated with thrombocytopenia. Regardless of the cause, thrombocytopenia is associated with more ischemic events, bleedings, and transfusions.

2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

“…Małopłytkowość jest niezależnym czynnikiem predykcyjnym złego rokowania obejmującego zgon, poważ-ne krwawienia i zagrażające życiu stany prozakrzepowe [503][504][505][506]. Istotną małopłytkowość zdefiniowano jako liczbę płytek < 100 000/µl lub względne obniżenie liczby płytek o > 50% w stosunku do wartości wyjściowych.…”

“…W 1 dużym RCT nie stwierdzono częstszego występowania małopłytkowo-ści < 100 000/µl w przypadku stosowania eptifibatidu w porównaniu z placebo (4,9% vs. 4,9%; p = 0,98) [503], lecz serie przypadków wskazują na możliwy związek między tym lekiem a trombocytopenią [511,512]. W bezpośrednim porównaniu abciximabu z tirofiban obserwowano małopłytkowość u odpowiednio 2,4% i 0,5% pacjentów (p < 0,001) [504]. W kolejnej metaanalizie 9 RCT częstość występowania małopłytkowości wynosiła 0,3% (tirofiban) w porównaniu z 2,4% (abciximab) [OR 0,28 (95% CI 0,08-0,94), p = 0,04] [510].…”

Trombocitopenia aguda pós-angioplastia coronária primária

“…3 Ainda não há um exame laboratorial que faça o diagnóstico de certeza, permacendo a trombocitopenia induzida pela heparina como uma condição de diagnóstico clínico apoiado por exames laboratoriais. 4,6 Os exames envolvem avaliações funcionais, em que a ativação plaquetária induzida pela heparina in vitro é testada para agregação, liberação de serotonina ou marcadores de ativação plaquetária. Alternativamente, imunoensaios enzimá-ticos para o complexo anticorpo-heparina-FP4 podem ser utilizados, tendo alta sensibilidade, mas baixa especificidade.…”

The Successful Use of Enoxaparin in the Lack of Bivalirudin in a Patient with Chronic Lymphocytic Leukemia and Thrombocytopenia who Underwent Percutaneous Coronary Revascularization

“…Ischemic and bleeding complications are seen more frequently in patients with thrombocytopenia and the selection of an anticoagulant therapy should be made carefully [2]. Anticoagulant therapy with unfractionated heparin (UFH) or UFH plus glycoprotein IIb/IIIa inhibitor is not appropriate in such patients [2,3].…”