title: Abciximab and bleeding during coronary surgery: results from the EPILOG and EPISTENT trials. Improve Long-term Outcome with abciximab GP IIb/IIIa blockade. Evaluation of Platelet IIb/IIIa Inhibition in STENTing.
abstract: BACKGROUND
  Abciximab during percutaneous coronary revascularization reduces ischemic complications, but concern exists regarding increased bleeding risk should emergency coronary surgical procedures be required.
  
  
  METHODS
  Outcomes were assessed among 85 patients who required coronary artery bypass grafting operations after coronary intervention in two randomized placebo-controlled trials of abciximab. Comparisons were made between patients in the pooled placebo and abciximab groups.
  
  
  RESULTS
  The incidence of coronary surgical procedures was 2.17% and 1.28% among patients randomized to placebo and abciximab, respectively (p = 0.021). Platelet transfusions were administered to 32% and 52% of patients in the placebo and abciximab groups, respectively (p = 0.059). Rates of major blood loss were 79% and 88% in the placebo and abciximab groups, respectively (p = 0.27); transfusions of packed red blood cells or whole blood were administered in 74% and 80% of patients, respectively (p = 0.53). Surgical reexploration for bleeding was required in 3% and 12% of patients, respectively. Death and myocardial infarction tended to occur less frequently among patients who had received abciximab.
  
  
  CONCLUSIONS
  Urgent coronary artery bypass grafting operations can be performed without an incremental increase in major hemorrhagic risk among patients on abciximab therapy.
authors.affiliation: Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Lincoff
authors.forename: L A
authors.initials: LA
authors.lastname: LeNarz
authors.forename: G J
authors.initials: GJ
authors.lastname: Despotis
authors.forename: P K
authors.initials: PK
authors.lastname: Smith
authors.forename: J E
authors.initials: JE
authors.lastname: Booth
authors.forename: R E
authors.initials: RE
authors.lastname: Raymond
authors.forename: S K
authors.initials: SK
authors.lastname: Sapp
authors.forename: C F
authors.initials: CF
authors.lastname: Cabot
authors.forename: J E
authors.initials: JE
authors.lastname: Tcheng
authors.forename: R M
authors.initials: RM
authors.lastname: Califf
authors.forename: M B
authors.initials: MB
authors.lastname: Effron
authors.forename: E J
authors.initials: EJ
authors.lastname: Topol
mesh_terms: D000077284:Abciximab; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D016063:Blood Loss, Surgical; D001026:Coronary Artery Bypass; D004638:Emergency Treatment; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D015337:Multicenter Studies as Topic; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D015607:Stents
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D000077284:Abciximab