[Abciximab-induced thrombopenia during treatment of acute coronary syndromes by angioplasty].
ReoPro (abciximab) is the Fab fragment of a chimeric monoclonal antibody directed against platelet glycoprotein IIb-IIIa. Its efficacy to prevent ischaemic complications after PTCA has been demonstrated in 3 studies: EPIC, EPILOG, UPTAKE. One hundred and sixty five cases of thrombocytopenia (< 100,000/microliter) were reported in a series of 5461 patients randomized in these 3 studies (i.e. 3.0%), including 46 (2.03%) with placebo and 119 (3.73% with abciximab. Among the 2270 patients randomized to receive placebo, 11 (0.48%) cases of severe thrombocytopenia (< 50,000/microliter) were observed versus 34 (1.07%) with abciximab. Major acute thrombocytopenia (< 20,000/microliter and < 24 hours) occurred in 0.60% (20 patients) of cases with abciximab. Their mechanism remains unknown. A therapeutic challenge did not modify either their incidence, or their severity. The development of thrombocytopenia did not worsen the patient's prognosis and course was always favourable. Twenty five cases of thrombocytopenia (0.60%), including 3 cases of acute major thrombocytopenia (0.08%) were spontaneously reported in France among the first 4000 patients treated with abciximab post-marketing. All patients treated with abciximab must be monitored by platelet count, 2 to 4 hours after the bolus administration, then 12 and 24 hours later. These platelet counts should be performed on 3 tubes (EDTA, citrate, heparin) in order to eliminate pseudothrombocytopenia and a differential diagnosis. In the case of true thrombocytopenia (< 10,000/l), treatment should be suspended and the platelet count should be repeated daily until return to normal. In the case of thrombocytopenia less than 60,000/microliter, heparin and aspirin should also be systematically discontinued and, below 50,000/microliter, platelet transfusion is justified.
Unité thérapeutique Cardio-vasculaire, Lilly-France, Saint-Cloud.
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Pinton
D000077284:Abciximab; D000208:Acute Disease; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000494:pharmacology*; D003327:Coronary Disease / Q000601:surgery*; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000494:pharmacology*; D017202:Myocardial Ischemia / Q000517:prevention & control*; D010919:Placebos; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology*; D013921:Thrombocytopenia / Q000139:chemically induced*
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010919:Placebos; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab
Thrombopénie sous abciximab dans le traitement des syndromes coronariens aigus par angioplastie.