Journal of Thrombosis and Thrombolysis

, Volume 19, Issue 3, pp 147–153

Safety of Abciximab Administration During PCI of Patients with Previous Stroke

  • Efthymios N. Deliargyris
  • Bharathi Upadhya
  • Robert J. Applegate
  • Jimmy L. Kontos
  • Michael A. Kutcher
  • Jeffrey S. Riesmeyer
  • David C. Sane
Article

Abstract

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.

Key Words

abciximab percutaneous coronary interventions stroke in-hospital events intracranial hemorrhage 

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References

  1. 1.
    The EPIC Investigators. Use of a monoclonal antibody directed against the platelet glycoprotein IIb-IIIa receptor in high–risk coronary angioplasty. N Engl J Med. 1994;30:956–961.Google Scholar
  2. 2.
    The EPILOG Investigators. Platelet glycoprotein IIb-IIIa receptor blockade and low-dose heparin during percutaneous coronary revascularization. N Engl J Med 1997;336:1689–1696.Google Scholar
  3. 3.
    The EPISTENT Investigators. Randomized placebo–controlled and balloon angioplasty-controlled trial to assess safety of coronary stenting with the use of platelet glycoprotein–IIb/IIIa blockade. Lancet 1998;352:87–92.Google Scholar
  4. 4.
    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.Google Scholar
  5. 5.
    The abciximab in ischemic stroke investigators. Abciximab in acute ischemic stroke: A randomized, double-blind, placebo-controlled, dose-escalation study. Stroke 2000;31(3):601–609.Google Scholar
  6. 6.
    Kapadia SR, Bajzer CT, Ziada KM, et al. Initial experience of platelet glycoprotein IIb/IIIa inhibition with abciximab during carotid stenting: A safe and effective adjunctive therapy. Stroke 2001;32(10):2328–2332.PubMedGoogle Scholar
  7. 7.
    Wallace RC, Furlan AJ, Moliterno DJ, Stevens GH, Masaryk TJ, Perl J 2nd. Basilar artery rethrombosis: Successful treatment with platelet glycoprotein IIB/IIIA receptor inhibitor. Am J Neuroradiol 1997;18(7):1257–1260.PubMedGoogle Scholar
  8. 8.
    Rao AK, Pratt C, Berke A, et al. 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 1988;11:1–11.PubMedGoogle Scholar
  9. 9.
    Akkerhuis KM, Deckers JW, Lincoff AM, et al. Risk of stroke associated with abciximab among patients undergoing percutaneous coronary intervention. JAMA 2001;286:78–82.CrossRefPubMedGoogle Scholar
  10. 10.
    Fuchs S, Stabile E, Kinnaird TD, et al. Stroke complicating percutaneous coronary interventions: Incidence, predictors, and prognostic implications. Circulation 2002;106:86–91.CrossRefPubMedGoogle Scholar
  11. 11.
    Dorros G, Cowley MJ, Simpson J, et al. Percutaneous transluminal coronary angioplasty: Report of complications from the national heart, lung, and blood institute PTCA registry. Circulation 1983;67:723–730.PubMedGoogle Scholar
  12. 12.
    Serruys PW, de Jaegere P, Kiemeneij F, et al. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med 1994;331:489–495.CrossRefPubMedGoogle Scholar
  13. 13.
    Fischman DL, Leon MB, Baim DS, et al. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med 1994;331:496–501.CrossRefPubMedGoogle Scholar
  14. 14.
    Schomig A, Neumann FJ, Kastrati A, et al. A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary-artery stents. N Engl J Med 1996;334:1084–1089.CrossRefPubMedGoogle Scholar
  15. 15.
    The bypass angioplasty revascularization investigation (BARI) investigators. Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. N Engl J Med 1996;335:217–225.Google Scholar
  16. 16.
    Zijlstra F, de Boer MJ, Hoorntje JC, Reiffers S, Reiber JH, Suryapranata H. A comparison of immediate coronary angioplasty with intravenous streptokinase in acute myocardial infarction. N Engl J Med 1993;328:680–684.CrossRefPubMedGoogle Scholar
  17. 17.
    Grines CL, Browne KF, Marco J, et al. A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction. The Primary Angioplasty in Myocardial Infarction Study Group. N Engl J Med 1993;328:673–679.CrossRefPubMedGoogle Scholar
  18. 18.
    The GUSTO-IIb angioplasty substudy investigators. A clinical trial comparing primary coronary angioplasty with tissue plasminogen activator for acute myocardial infarction. N Engl J Med 1997;336:1621–1628Google Scholar
  19. 19.
    Weaver WD, Simes RJ, Betriu A, et al. Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: A quantitative review. JAMA 1997;278:2093–2098.CrossRefPubMedGoogle Scholar
  20. 20.
    Tiefenbrunn AJ, Chandra NC, French WJ, Gore JM, Rogers WJ. 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 1998;31:1240–1245.CrossRefPubMedGoogle Scholar
  21. 21.
    Antman EM, Giugliano RP, Gibson CM, et al. Abciximab facilitates the rate and extent of thrombolysis: Results of the thrombolysis in myocardial infarction (TIMI) 14 trial. The TIMI 14 Investigators. Circulation 1999;99(21):2720–2732.PubMedGoogle Scholar
  22. 22.
    Weiller C, Ringelstein EB, Reiche W, Buell U. Clinical and hemodynamic aspects of low-flow infarcts. Stroke 1991;22:1117–1123.PubMedGoogle Scholar
  23. 23.
    Miyazawa N, Hashizume K, Uchida M, Nukui H. Long-term follow-up of asymptomatic patients with major artery occlusion: Rate of symptomatic change and evaluation of cerebral hemodynamics. Am J Neuroradiol 2001;22:243–247.PubMedGoogle Scholar
  24. 24.
    Stone GW, Marsalese D, Brodie BR, et al. 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 1997;29:1459–1467.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Efthymios N. Deliargyris
    • 1
  • Bharathi Upadhya
    • 1
  • Robert J. Applegate
    • 1
  • Jimmy L. Kontos
    • 1
  • Michael A. Kutcher
    • 1
  • Jeffrey S. Riesmeyer
    • 2
  • David C. Sane
    • 1
    • 3
  1. 1.Cardiology SectionWake Forest University School of MedicineWinston-SalemNC
  2. 2.Eli Lilly Inc.USA
  3. 3.Cardiology Section, Medical Center BoulevardWake Forest University School of MedicineWinston-SalemUSA

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