Fatal cerebral hemorrhage and severe thrombocytopenia during abciximab treatment

Vahdat, Bruno; Canavy, Isabelle; Fourcade, Laurent; García, Eric; Quilici, Jacques; Bonnet, Jean‐Louis; Bory, M

doi:10.1002/(sici)1522-726x(200002)49:2<177::aid-ccd13>3.0.co;2-j

Cited by 25 publications

(10 citation statements)

References 17 publications

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“…Thrombocytopaenia is a well known complication of these drugs with an incidence of between 0.2% and 4.6% in clinical trials, depending on whether thrombocytopaenia was defined as a platelet count of lower than 20×10 9 /L, 50×10 9 /L or 100×10 9 /L [25]. Haematemesis, life-threatening bleeding, intracranial haemorrhage or fatal shock have been described as complications [26][27][28][29]. In contrast to other types of DITP, GP IIb/ IIIa-antagonist-associated thrombocytopaenia usually develops rapidly within a few hours after drug exposure, although delayed onset thrombocytopaenia has been described in several patients exposed to abciximab [30,31].…”

Section: Discussionmentioning

confidence: 99%

Drug-induced immune thrombocytopaenia: results from the Berlin Case–Control Surveillance Study

Garbe

Andersohn

Bronder

et al. 2011

Eur J Clin Pharmacol

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Section: Discussionmentioning

confidence: 99%

Drug-induced immune thrombocytopaenia: results from the Berlin Case–Control Surveillance Study

Garbe

Andersohn

Bronder

et al. 2011

Eur J Clin Pharmacol

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“…The toxicity includes peripheral and cerebral hemorrhage 30 -35 and thrombocytopenia. 34 A review of the pertinent literature indicates that the majority of the side effects noted may be related to chronic rather than acute administration of platelet inhibitors. However, there are some exceptions to that statement.…”

Section: Discussionmentioning

confidence: 99%

The Nonpeptide Glycoprotein IIb/IIIa Platelet Receptor Antagonist SM-20302 Reduces Tissue Plasminogen Activator–Induced Intracerebral Hemorrhage After Thromboembolic Stroke

Lapchak

Araujo²,

Song³

et al. 2002

Stroke

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Background and Purpose-Platelet activation and deposition in brain microvessels appear to be key events in the pathogenesis of ischemia-induced neuronal degeneration and behavioral deficits. It has been hypothesized that activated platelets in combination with polymorphonuclear leukocytes and fibrin may play a role in vessel reocclusion leading to the "no-reflow" phenomenon after administration of the thrombolytic tissue plasminogen activator (tPA). We studied the effects of the novel glycoprotein IIb/IIIa platelet receptor antagonist SM-20302 when administered in combination with tPA on infarct and hemorrhage rate and volume to determine whether activated platelets are involved in either infarct or hemorrhage generation after a thromboembolic stroke. Methods-One hundred thirty-two male New Zealand White rabbits were included in the present study. Rabbits were embolized by injecting a blood clot into the middle cerebral artery via a catheter. Five or 65 minutes after embolization, SM-20302 (5 mg/kg) was infused intravenously. In drug combination studies, tPA was infused intravenously for 30 minutes starting 60 minutes after embolization, and SM-20302 was administered 5 or 65 minutes after embolization. Postmortem analysis included assessment of hemorrhage, infarct size and location, and clot lysis. Results-In the vehicle control group, the hemorrhage rate after a thromboembolic stroke was 33%. There was a significant increase (109%) in the hemorrhage rate in the group of rabbits treated with the thrombolytic tPA. SM-20302 by itself did not significantly alter the embolism-induced hemorrhage rate when administered either 5 or 65 minutes after embolism. The SM-20302 groups had a 42% and 33% incidence of hemorrhage in the 5-and 65-minute groups, respectively. In groups treated with a combination of drugs, the SM-20302/tPA group had a 31% and 71% incidence of hemorrhage when SM-20302 was administered 5 and 65 minutes after embolization, respectively. SM-20302 in combination with tPA also significantly increased infarct rate, but not hemorrhage or infarct volume. Conclusions-This study suggests that treatment of thromboembolic stroke with the combination of a platelet inhibitor and tPA may have a beneficial outcome on the basis of the following: First, acute administration of SM-20302 did not significantly increase hemorrhage rate. Second, SM-20302 in combination with tPA significantly reduced tPA-induced intracerebral hemorrhage. Third, there appears to be a specific window of opportunity when a platelet inhibitor must be administered to produce a beneficial effect. Overall, on the basis of our results, we hypothesize that the increased rate of intracerebral hemorrhage observed after tPA administration may be partly due to increased reocclusion of cerebral vessels following lysis of the emboli and that reocclusion can be controlled by administration of a platelet inhibitor.

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“…Experience with abciximab in this setting is limited; its safety and efficacy in association with neuroendovascular procedures has not been clearly defined. Major bleeding complications, including fatal intracranial hemorrhage (ICH), have been reported with the use of GPIs [1,9,12,13,16,19,20]. In the current study, we relate our multicenter experience with ICH following administration of abciximab during neuroendovascular procedures.…”

Section: Introductionmentioning

confidence: 99%

Intracranial Hemorrhage Following Neuroendovascular Procedures with Abciximab is Associated with High Mortality: A Multicenter Series

et al. 2010

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Fatal cerebral hemorrhage and severe thrombocytopenia during abciximab treatment

Cited by 25 publications

References 17 publications

Drug-induced immune thrombocytopaenia: results from the Berlin Case–Control Surveillance Study

Drug-induced immune thrombocytopaenia: results from the Berlin Case–Control Surveillance Study

The Nonpeptide Glycoprotein IIb/IIIa Platelet Receptor Antagonist SM-20302 Reduces Tissue Plasminogen Activator–Induced Intracerebral Hemorrhage After Thromboembolic Stroke

Intracranial Hemorrhage Following Neuroendovascular Procedures with Abciximab is Associated with High Mortality: A Multicenter Series

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