Incidence of thrombocytopenia following coronary stent placement using abciximab plus clopidogrel or ticlopidine

Dillon, William C.; Eckert, George J.; Dillon, James C.; Ritchie, Michael E.

doi:10.1002/1522-726x(200008)50:4<426::aid-ccd12>3.0.co;2-l

Cited by 12 publications

(5 citation statements)

References 14 publications

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“…On the other hand, the majority of our patients in both treatment groups were also treated with abciximab and the frequency of bleeding complications or severe thrombocytopenia in the present study is compatible with that encountered in previous trials on abciximab therapy [23, 24]. Therefore, our findings are in contrast with those of a study in 25 patients according to which the combination of a loading dose of clopidogrel with abciximab during stenting further increased the risk for thrombocytopenia [25].…”

Section: Discussionsupporting

confidence: 90%

Clopidogrel therapy in patients undergoing coronary stenting: Value of a high‐loading‐dose regimen

Pache

Kastrati

Mehilli

et al. 2002

Cathet Cardio Intervent

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The objective of this study was to assess the value of a clopidogrel regimen based on a high loading dose initiated before the stent placement procedure. A consecutive series of 864 patients treated with a high-loading-dose clopidogrel regimen (600 mg given 2-4 hr prior to intervention) was compared with 870 patients treated with conventional ticlopidine therapy. Abciximab was given periprocedurally in 62% of the patients. The composite endpoint of death, myocardial infarction, or urgent revascularization was reached by 39 (4.5%) clopidogrel patients and 59 (6.8%) ticlopidine patients. Clopidogrel therapy was associated with a 35% reduction of the risk for early adverse events (odds ratio 0.65; 95% confidence interval, 0.43-0.98). Thus, a high-loading-dose clopidogrel regimen in patients undergoing coronary artery stenting was safe and led to a more favorable clinical outcome than conventional therapy with ticlopidine regardless of concomitant treatment with abciximab.

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Section: Discussionsupporting

confidence: 90%

Clopidogrel therapy in patients undergoing coronary stenting: Value of a high‐loading‐dose regimen

Pache

Kastrati

Mehilli

et al. 2002

Cathet Cardio Intervent

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“…Interestingly, Taniuchi et al [32] showed in 228 patients treated with clopidogrel (300 mg loading dose) in conjunct with GPIIb/IIIa receptor antagonists that the incidence of thrombocytopenia was not significantly higher for combination therapy as compared for the respective GPIIb/IIIa receptor blockers alone. In contrast a higher incidence of thrombocytopenia in patients receiving an oral loading dose of 300 mg clopidogrel in conjunction with abciximab was reported [19]. Moreover, it could be demonstrated that abciximab combined with unfractionated heparin leads to a significant increase in mild and severe thrombocytopenia, whereas this effect could not be shown for unfractionated heparin in conjunction with the small molecule GP IIb/IIIa receptor inhibitors [31].…”

Section: Discussionmentioning

confidence: 92%

“…Development of thrombocytopenia within 24 h is most likely caused by the administration of the glycoprotein IIb/IIIa-antagonists abciximab, eptifibatide and tirofiban, respectively [17, 19,22]. It has been discussed that binding of the antagonists to the glycoprotein receptor may lead to exposure of a ligand induced binding site which is then recognized by either preexisting or inducable antibodies [17,28].…”

Section: Discussionmentioning

confidence: 99%

“…There are considerable pharmacological differences between abciximab and the other GPIIb/IIIa inhibitors tirofiban and eptifibatide [30] and the incidence of thrombocytopenia with abciximab seems to be higher as compared with the other two agents. Abciximab has been reported to be associated with the development of general thrombocytopenia (<100,000/mm 3 ) in 2.5-5.6%, and with acute profound thrombocytopenia in 0.3 and 0.8% of cases, respectively [13,17,19,22]. In nine multicenter studies (24,946 patients in total) the incidence of thrombocytopenia of <100,000/mm 3 was 5.4% with abciximab, 3% with small molecular GPIIb/IIIa inhibitors, and 2.8% with heparin alone [28].…”

Section: Discussionmentioning

confidence: 99%

“…Antiplatelet-drug induced thrombocytopenia following PCI, although relatively rare, is a well known phenomenon [16][17][18][19][20][21][22]. It is extremely rare when clopidogrel is used (up to 0.6%) [2, 23], but more frequently seen in patients, who are additionally treated with GP IIb/IIIa-blockers (2.5-5.6%) [13,19,22]. Also heparin-induced thrombocytopenia is a rare finding in interventional cardiology (1%) [24][25][26].…”

Section: Introductionmentioning

confidence: 99%

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Antiplatelet drug induced isolated profound thrombocytopenia in interventional cardiology: a review based on individual case reports

Höchtl

Pachinger

Unger

et al. 2007

J Thromb Thrombolysis

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A combination antithrombotic and antiplatelet therapy with clopidogrel, aspirin, glycoprotein IIb/IIIa receptor inhibitors and heparins is routinely used as adjunct therapy in patients undergoing percutaneous coronary intervention (PCI). As all substances inhibit platelet function, bleeding and thrombocytopenia may occur. We report on three patients who developed isolated profound thrombocytopenia (platelet count of < 20,000/mm(3)) within 24 h after initiation of combination antiplatelet and antithrombotic therapy during a 1 year observation period in 443 consecutive patients undergoing PCI and stent implantation. The data from our cardiology unit revealed an incidence of an isolated profound thrombocytopenia in 0.7% of all patients on combination antithrombotic therapy and in 1.5% of patients with GPIIb/IIIa-blockers. In all three cases with isolated profound thrombocytopenia GPIIb/IIIa-blockers were found to be the causative agents. Negative results of HIT-assays excluded heparin induced thrombocytopenia type II. Despite the extremely low platelet count no severe bleeding was observed and in all cases platelet counts normalized within 3-4 days without specific interventions except discontinuation of the responsible agent. These findings are discussed in conjunct with an overview of the recent literature.

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Aspirin alone antiplatelet regimen after intracoronary placement of the Carbostent™: The Antares study

Bartorelli

Trabattoni

Montorsi

et al. 2002

Cathet Cardio Intervent

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The effect of stent coatings in preventing early thrombotic occlusion remains to be proved. The purpose of this study was to evaluate the safety and efficacy of the Carbostent, a new coronary stent with a nonthrombogenic coating (Carbofilm), in 110 consecutive patients (73.6% men, mean age 61 +/- 9 years) who met prespecified clinical and angiographic inclusion criteria and were treated with aspirin monotherapy after stenting. Stable angina (75.5%), unstable angina (18.2%), and silent ischemia (6.3%) were clinical indications for coronary revascularization. Patients received 10,000 U of heparin and no IIb/IIIa inhibitors or postprocedural heparin. Complex lesion characteristics (B2, C) were present in 39 out of 129 (30.2%) lesions. Mean lesion length was 15.6 +/- 7.4 mm, and 32% of the lesions were >15 mm (range 16-52 mm). Small coronary vessels (<3.0 mm) were treated in 28% of the cases. A total of 165 Carbostent were used in 129 coronary lesions of the 110 patients. Single-vessel stenting was performed in 97 (88%) patients and multivessel stent placement in 13 (12%) patients. The mean length of the stented segment was 21 +/- 13 mm (range 9-95 mm). Procedural and clinical success was achieved in all patients. At 1-month follow-up, there were no stent thrombosis or other major adverse cardiac events. We observed 2 (1.8%) non-Q-wave myocardial infarctions and 2 (1.8%) vascular complications. This study indicates that the Carbostent may prevent stent thrombosis in selected patients treated with aspirin only. A randomized study comparing aspirin alone versus combined ticlopidine and aspirin after Carbostent implantation will be needed to confirm these results.

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Incidence of thrombocytopenia following coronary stent placement using abciximab plus clopidogrel or ticlopidine

Cited by 12 publications

References 14 publications

Clopidogrel therapy in patients undergoing coronary stenting: Value of a high‐loading‐dose regimen

Clopidogrel therapy in patients undergoing coronary stenting: Value of a high‐loading‐dose regimen

Antiplatelet drug induced isolated profound thrombocytopenia in interventional cardiology: a review based on individual case reports

Aspirin alone antiplatelet regimen after intracoronary placement of the Carbostent™: The Antares study

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