Trombocitopenia extrema secundaria a abciximab

Los antiagregantes antiglucoproteína IIb/IIIa bloquean la unión del fibrinógeno y el factor de Von Willebrand a sus receptores. Pueden causar hemorragia y trombocitopenia. Se ha analizado la incidencia y la repercusión clínica de la trombocitopenia extrema severa (< 20.000 por µl) secundaria a abciximab en un estudio prospectivo de 375 pacientes (el 74%, varones) sometidos a cateterismo cardíaco percutáneo y tratados con abciximab en nuestro hospital. Se registraron las características clínicas, demográficas, del procedimiento y los datos analíticos, así como el recuento plaquetario (antes del procedimiento y a las 4 y 12 h de éste) y el hematocrito. La incidencia de trombocitopenia aguda extrema en los 375 pacientes fue del 1,1%. Todos fueron varones y no presentaron complicaciones hemorrágicas relevantes. Debe considerarse esta complicación en las primeras horas posteriores a la administración del fármaco. Su manejo consistió en vigilancia del sangrado, suspensión del fármaco y transfusión plaquetaria

Antithrombotic treatment during coronary angioplasty after failed thrombolysis: strategies and prognostic implications. Results of the RESPIRE registry

Abstract Background Thrombolysis is still used when primary angioplasty is delayed for a long time, but 25%–30% of patients require rescue angioplasty (RA). There are no established recommendations for antithrombotic management in RA. This registry analyzes regimens for antithrombotic management. Methods A retrospective, multicenter, observational registry of consecutive patients treated with RA at 8 hospitals. All variables were collected and follow-up took place at 6 months. Results The study included 417 patients. Antithrombotic therapy in RA was: no additional drugs 22.3%, unfractionated heparin (UFH) 36.6%, abciximab 15.5%, abciximab plus UFH 10.5%, bivalirudin 5.7%, enoxaparin 4.3%, and others 4.7%. Outcomes at 6 months were: mortality 9.1%, infarction 3.3%, definite or probable stent thrombosis 4.3%, revascularization 1.9%, and stroke 0.5%. Mortality was related to cardiogenic shock, age > 75 years, and anterior location. The stent thrombosis rate was highest with bivalirudin (12.5% at 6 months). The incidence of bleeding at admission was high (14.8%), but most cases were not severe (82% BARC ≤2). Variables independently associated with bleeding were: femoral access (OR 3.30; 95% CI 1.3–8.3: p = 0.004) and post-RA abciximab infusion (OR 2.26; 95% CI 1.02–5: p = 0.04). Conclusions Antithrombotic treatment regimens in RA vary greatly, predominant strategies consisting of no additional drugs or UFH 70 U/kg. No regimen proved predictive of mortality, but bivalirudin was related to more stent thrombosis. There was a high incidence of bleeding, associated with post-RA abciximab infusion and femoral access