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Clinical correlates and course of thrombocytopenia during percutaneous coronary intervention in the era of abciximab platelet glycoprotein IIb/IIIa blockade.

Publication ,  Journal Article
Kereiakes, DJ; Berkowitz, SD; Lincoff, AM; Tcheng, JE; Wolski, K; Achenbach, R; Melsheimer, R; Anderson, K; Califf, RM; Topol, EJ
Published in: Am Heart J
July 2000

BACKGROUND: Thrombocytopenia is infrequently associated with abciximab therapy but may contribute to hemorrhagic risk. Factors associated with development of thrombocytopenia, the role of weight-adjustment in concomitant heparin administration, and clinical outcomes in patients with thrombocytopenia are not well defined. METHODS AND RESULTS: Pooled data from 3 placebo-controlled, randomized trials (EPIC, EPILOG, and EPISTENT) of abciximab therapy during percutaneous coronary intervention identified 178 patients (2. 4% of 7290 patients) in whom thrombocytopenia (platelet count <100 x 10(9)/L) developed after enrollment. Multivariate regression analysis identified age (>65 years; P <.001), weight (<90 kg; P =. 023), baseline platelet count (<200 x 10(9)/L; P <.001), abciximab therapy (P =.002), and enrollment into the EPIC trial (P <.001) to be associated with development of thrombocytopenia. Major and minor nonsurgical hemorrhage and transfusion were more frequent (all P <. 001) in thrombocytopenic patients. Although the primary composite clinical end point of these trials (death, myocardial infarction, or urgent revascularization to 30 days) was observed with similar frequency in patients with (11.2%) and those without (7.9%; P =.114) thrombocytopenia, 30-day mortality rate was higher in thrombocytopenic patients (8.4% vs 0.6%, respectively; P <.001). This excess mortality rate persisted after excluding patients in whom thrombocytopenia was first noted after the performance of coronary bypass surgery (4.8% vs 0.6%; P <.001). Among patients in whom thrombocytopenia developed during these trials, those who received prophylactic abciximab had fewer primary end point events (7.1% vs 23.1%; P =.056) and had a lower 30-day mortality rate (3.5% vs 15.4%; P =.048) than patients with thrombocytopenia who had received prophylactic placebo. CONCLUSIONS: Thrombocytopenia associated with abciximab therapy for percutaneous coronary intervention was more frequent in older, lighter-weight patients, those with lower baseline platelet counts, and in those patients who were enrolled into the EPIC trial. Both bleeding and transfusion events occur more frequently in patients with thrombocytopenia. Patients in whom thrombocytopenia developed during these trials had increased mortality rates to 30 days not attributable to the performance of coronary bypass surgery. Among patients with thrombocytopenia, those who received prophylactic abciximab had better clinical outcomes including survival than those who did not.

Duke Scholars

Published In

Am Heart J

DOI

ISSN

0002-8703

Publication Date

July 2000

Volume

140

Issue

1

Start / End Page

74 / 80

Location

United States

Related Subject Headings

  • Thrombocytopenia
  • Survival Rate
  • Sex Distribution
  • Risk Factors
  • Probability
  • Platelet Aggregation Inhibitors
  • Odds Ratio
  • Myocardial Infarction
  • Multivariate Analysis
  • Middle Aged
 

Citation

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Kereiakes, D. J., Berkowitz, S. D., Lincoff, A. M., Tcheng, J. E., Wolski, K., Achenbach, R., … Topol, E. J. (2000). Clinical correlates and course of thrombocytopenia during percutaneous coronary intervention in the era of abciximab platelet glycoprotein IIb/IIIa blockade. Am Heart J, 140(1), 74–80. https://doi.org/10.1067/mhj.2000.106615
Kereiakes, D. J., S. D. Berkowitz, A. M. Lincoff, J. E. Tcheng, K. Wolski, R. Achenbach, R. Melsheimer, K. Anderson, R. M. Califf, and E. J. Topol. “Clinical correlates and course of thrombocytopenia during percutaneous coronary intervention in the era of abciximab platelet glycoprotein IIb/IIIa blockade.Am Heart J 140, no. 1 (July 2000): 74–80. https://doi.org/10.1067/mhj.2000.106615.
Kereiakes DJ, Berkowitz SD, Lincoff AM, Tcheng JE, Wolski K, Achenbach R, et al. Clinical correlates and course of thrombocytopenia during percutaneous coronary intervention in the era of abciximab platelet glycoprotein IIb/IIIa blockade. Am Heart J. 2000 Jul;140(1):74–80.
Kereiakes, D. J., et al. “Clinical correlates and course of thrombocytopenia during percutaneous coronary intervention in the era of abciximab platelet glycoprotein IIb/IIIa blockade.Am Heart J, vol. 140, no. 1, July 2000, pp. 74–80. Pubmed, doi:10.1067/mhj.2000.106615.
Kereiakes DJ, Berkowitz SD, Lincoff AM, Tcheng JE, Wolski K, Achenbach R, Melsheimer R, Anderson K, Califf RM, Topol EJ. Clinical correlates and course of thrombocytopenia during percutaneous coronary intervention in the era of abciximab platelet glycoprotein IIb/IIIa blockade. Am Heart J. 2000 Jul;140(1):74–80.
Journal cover image

Published In

Am Heart J

DOI

ISSN

0002-8703

Publication Date

July 2000

Volume

140

Issue

1

Start / End Page

74 / 80

Location

United States

Related Subject Headings

  • Thrombocytopenia
  • Survival Rate
  • Sex Distribution
  • Risk Factors
  • Probability
  • Platelet Aggregation Inhibitors
  • Odds Ratio
  • Myocardial Infarction
  • Multivariate Analysis
  • Middle Aged