Alveolar Hemorrhage: An Underdiagnosed Complication of Treatment with Glycoprotein IIb/IIIa Inhibitors

Abstract

AH is a rare complication of treatment with GP IIb/IIIa inhibitors. Its incidence ranged from 0.14% in patients treated with abciximab to 0.33% in those receiving eptifibatide. Compared to a control group, patients treated with GP IIb/IIIa inhibitors had a statistically increased risk for AH.

A fatal complication of tirofiban in an octogenarian: Diffuse alveolar hemorrhage

“…In the same study, there was no severe pulmonary hemorrhage in the control group, which consisted of 5412 patients that underwent coronary interventions without abciximab. On the other hand, Iskandar et al [1] reported diffuse alveolar hemorrhage incidence as 0.33% (6 of 1810) for eptifibatide and 0.14% (5 of 3648) for abciximab in the setting of AMI.…”

“…On the other hand, although seven cases of diffuse alveolar hemorrhage following tirofiban administration have been reported in the literature, no cases with diffuse alveolar hemorrhage as a complication of isolated acetylsalicylic acid, clopidogrel, or heparin administration have been presented to date. A large-scale retrospective analysis of 5458 acute myocardial infarction (AMI) patients treated with abciximab or eptifibatide and 4136 AMI patients treated without GP IIb/IIIa inhibitors found that GP IIb/IIIa inhibitors statistically increase the risk of diffuse alveolar hemorrhage [1]. A total of 11 patients showed typical signs (dyspnea, hemoptysis, arterial hypoxemia, pulmonary radiographic changes, and, if possible, bronchoscopic signs) of diffuse alveolar hemorrhage in the GP IIb/IIIa inhibitor group.…”

Eptifibatide overdose

“…Intra-cranial bleeding has been reported with eptifibatide, but in large randomized trials, the rates were not greater than that of placebo [27,33]. Alveolar hemorrhage has been reported with eptifibatide [34], but it is a rare complication [35,36] that presents with hemoptysis, dyspnea or new infiltrates on chest X-ray [34][35][36].…”

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.…”