Abciximab-Induced Alveolar Hemorrhage after Percutaneous Coronary Intervention.

Abstract

A bciximab, a platelet glycoprotein (GP) IIb/IIIa inhibitor, has been shown to improve clinical outcomes in patients undergoing percutaneous coronary intervention (PCI). However, there is a well-documented increase in bleeding risk associated with use of this agent. Several types of bleeding, including groin site, intracranial, gastrointestinal, genitourinary and pulmonary, have been described. Spontaneous pulmonary hemorrhage is a particularly rare and easily misdiagnosed complication that requires early diagnosis to ensure patient survival. CASE PRESENTATIONA 61-year-old man with no previous history of coronary artery disease presented to the emergency department for evaluation of chest pain associated with diaphoresis. His initial electrocardiogram Abciximab, a platelet glycoprotein (GP) IIb/IIIa inhibitor, has been shown to improve clinical outcomes in patients undergoing percutaneous coronary intervention. However, there is a well-documented increase in bleeding risk associated with the use of this agent. Spontaneous pulmonary hemorrhage is a particularly rare and easily misdiagnosed complication that requires early diagnosis to ensure patient survival. A 61-year-old man presented to the emergency department with chest pain and inferolateral ST elevation on electrocardiogram. A paclitaxel drugeluting stent was then placed in the left circumflex artery, without complications. Abciximab (a bolus of 0.25 mg/kg followed by an infusion of 10 mg/min for 12 h) was given. Approximately 20 min later, the patient developed dyspnea and hemoptysis. A chest radiograph revealed new bilateral diffuse interstitial infiltrates, and the patient was started on empirical antibiotics for pneumonia. Because of increasing dyspnea and somnolence, the patient was intubated and bronchoscopy was performed, revealing serial hemorrhagic returns from the left lower lobe, diagnostic of diffuse alveolar hemorrhage and judged to be secondary to abciximab, given the time course. All antiplatelet and antithrombotic agents were stopped. The patient stabilized over the next several days, with some recurrent hemoptysis, and was successfully extubated seven days later. Prognosis remains poor in GP IIb/IIIa inhibitor-induced pulmonary hemorrhage, and early diagnosis is critical so that antithrombotic and antiplatelet agents may be discontinued in a timely manner. A high degree of suspicion is required when treating a patient who presents with dyspnea and new radiological infiltrates after receiving a GP IIb/IIIa inhibitor.

Successful management of warfarin-exacerbated diffuse alveolar hemorrhage using an extracorporeal membrane oxygenation

“…In the future, the incidence of anticoagulants-induced DAH may increase because of the growth of elderly population, who need anticoagulants due to conditions, such as atrial fibrillation, cardiovascular diseases, and valvular heart diseases. Furthermore, the new anticoagulants, such as abciximab and epifibatide, are more potent, and DAH induced by these drugs has recently been recently reported [13,14].…”

Diffuse alveolar haemorrhage secondary to warfarin therapy for atrial fibrillation: a case report and literature review

“…Even though DAH induced by anticoagulation agents remains rare, its incidence may increase because of (i) the use of newer, more potent agents such as abciximab28 and eptifibatide29 and (ii) the use of warfarin and these agents in an increasingly elderly population with co-morbidities and polypharmacy.…”