Safety of Abciximab Administration During PCI of Patients with Previous Stroke
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Objectives: To examine the frequency of cerebrovascular complications among patients receiving abciximab (AB) undergoing PCI with prior intracranial hemorrhage (ICH) or recent (< 2 years) ischemic strokes.
Background: AB improves clinical outcomes in high-risk patients undergoing percutaneous coronary intervention (PCI); however, the safety of AB in patients with prior stroke has not been adequately studied.
Methods: A database review of 7,244 consecutive PCIs, from 7/97 to 10/01, identified 6,190 PCIs performed with AB among which 515 interventions were performed in patients with prior stroke history [ICH or recent ischemic stroke, (n = 101) and remote (> 2 years) ischemic stroke, (n = 414)].
Results: The post-PCI stroke rate was significantly higher in patients with prior stroke (2.06% vs. 0.35%, p < 0.001 for all stroke; 0.38% vs. 0.03%, p = 0.023 for ICH). The incidence of ICH among the AB-treated group was 0.065%; a history of prior stroke did not increase the incidence of ICH in the AB-treated group (0.39% vs. 0.0%, p = ns). Moreover, the post-PCI stroke rate was similar between the prior ICH or recent ischemic stroke–group and remote ischemic stroke-group (2 vs. 1.9%; OR: 1.03; 95% CI: 0.21–4.90; p = ns for all strokes; 2% vs. 1.5%; OR: 1.4; 95% CI: 0.27–6.91; p = ns for ischemic stroke). Importantly, no ICH occurred in patients with recent ischemic or any prior ICH stroke.
Conclusions: Abciximab, in addition to aspirin, heparin and ADP-inhibitors does not increase the risk of stroke in patients with prior stroke undergoing PCI.
- Use of a monoclonal antibody directed against the platelet glycoprotein IIb-IIIa receptor in high–risk coronary angioplasty. N Engl J Med 30: pp. 956-961
- Platelet glycoprotein IIb-IIIa receptor blockade and low-dose heparin during percutaneous coronary revascularization. N Engl J Med 336: pp. 1689-1696
- Randomized placebo–controlled and balloon angioplasty-controlled trial to assess safety of coronary stenting with the use of platelet glycoprotein–IIb/IIIa blockade. Lancet 352: pp. 87-92
- The CAPTURE investigators randomized placebo-controlled trial of abciximab before and during coronary intervention in refractory unstable angina: The CAPTURE study. Lancet 1997;349:1429–1435.
- Abciximab in acute ischemic stroke: A randomized, double-blind, placebo-controlled, dose-escalation study. Stroke 31: pp. 601-609
- Kapadia, SR, Bajzer, CT, Ziada, KM (2001) Initial experience of platelet glycoprotein IIb/IIIa inhibition with abciximab during carotid stenting: A safe and effective adjunctive therapy. Stroke 32: pp. 2328-2332
- Wallace, RC, Furlan, AJ, Moliterno, DJ, Stevens, GH, Masaryk, TJ, Perl, J 2nd (1997) Basilar artery rethrombosis: Successful treatment with platelet glycoprotein IIB/IIIA receptor inhibitor. Am J Neuroradiol 18: pp. 1257-1260
- Rao, AK, Pratt, C, Berke, A (1988) Thrombolysis in Myocardial Infarction (TIMI) Trial -phase I: Hemorrhagic manifestations and changes in plasma fibrinogen and the fibrinolytic system in patients treated with recombinant tissue plasminogen activator and streptokinase. J Am Coll Cardiol 11: pp. 1-11
- Akkerhuis, KM, Deckers, JW, Lincoff, AM (2001) Risk of stroke associated with abciximab among patients undergoing percutaneous coronary intervention. JAMA 286: pp. 78-82 CrossRef
- Fuchs, S, Stabile, E, Kinnaird, TD (2002) Stroke complicating percutaneous coronary interventions: Incidence, predictors, and prognostic implications. Circulation 106: pp. 86-91 CrossRef
- Dorros, G, Cowley, MJ, Simpson, J (1983) Percutaneous transluminal coronary angioplasty: Report of complications from the national heart, lung, and blood institute PTCA registry. Circulation 67: pp. 723-730
- Serruys, PW, de Jaegere, P, Kiemeneij, F (1994) A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med 331: pp. 489-495 CrossRef
- Fischman, DL, Leon, MB, Baim, DS (1994) A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med 331: pp. 496-501 CrossRef
- Schomig, A, Neumann, FJ, Kastrati, A (1996) A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents. N Engl J Med 334: pp. 1084-1089 CrossRef
- Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. N Engl J Med 335: pp. 217-225
- Zijlstra, F, de Boer, MJ, Hoorntje, JC, Reiffers, S, Reiber, JH, Suryapranata, H (1993) A comparison of immediate coronary angioplasty with intravenous streptokinase in acute myocardial infarction. N Engl J Med 328: pp. 680-684 CrossRef
- Grines, CL, Browne, KF, Marco, J (1993) A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction. The Primary Angioplasty in Myocardial Infarction Study Group. N Engl J Med 328: pp. 673-679 CrossRef
- A clinical trial comparing primary coronary angioplasty with tissue plasminogen activator for acute myocardial infarction. N Engl J Med 336: pp. 1621-1628
- Weaver, WD, Simes, RJ, Betriu, A (1997) Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: A quantitative review. JAMA 278: pp. 2093-2098 CrossRef
- Tiefenbrunn, AJ, Chandra, NC, French, WJ, Gore, JM, Rogers, WJ (1998) Clinical experience with primary percutaneous transluminal coronary angioplasty compared with alteplase in patients with acute myocardial infarction: A report from the Second National Registry of Myocardial Infarction (NRMI-2). J Am Coll Cardiol 31: pp. 1240-1245 CrossRef
- Antman, EM, Giugliano, RP, Gibson, CM (1999) Abciximab facilitates the rate and extent of thrombolysis: Results of the thrombolysis in myocardial infarction (TIMI) 14 trial. The TIMI 14 Investigators. Circulation 99: pp. 2720-2732
- Weiller, C, Ringelstein, EB, Reiche, W, Buell, U (1991) Clinical and hemodynamic aspects of low-flow infarcts. Stroke 22: pp. 1117-1123
- Miyazawa, N, Hashizume, K, Uchida, M, Nukui, H (2001) Long-term follow-up of asymptomatic patients with major artery occlusion: Rate of symptomatic change and evaluation of cerebral hemodynamics. Am J Neuroradiol 22: pp. 243-247
- Stone, GW, Marsalese, D, Brodie, BR (1997) A prospective, randomized evaluation of prophylactic intraaortic balloon counterpulsation in high risk patients with acute myocardial infarction treated with primary angioplasty: Second primary angioplasty in myocardial infarction (PAMI-II) trial investigators. J Am Coll Cardiol 29: pp. 1459-1467 CrossRef
- Safety of Abciximab Administration During PCI of Patients with Previous Stroke
Journal of Thrombosis and Thrombolysis
Volume 19, Issue 3 , pp 147-153
- Cover Date
- Print ISSN
- Online ISSN
- Kluwer Academic Publishers
- Additional Links
- percutaneous coronary interventions
- in-hospital events
- intracranial hemorrhage
- Industry Sectors
- Author Affiliations
- 1. Cardiology Section, Wake Forest University School of Medicine, Winston-Salem, NC
- 2. Eli Lilly Inc., USA
- 3. Cardiology Section, Medical Center Boulevard, Wake Forest University School of Medicine, Winston-Salem, NC, 27157-1045, USA