Use of platelet glycoprotein IIb/IIIa inhibitors and spontaneous pulmonary hemorrhage.
BACKGROUND
The use of platelet glycoprotein (GP) IIb/IIIa inhibitors in patients undergoing percutaneous coronary intervention has resulted in an impressive reduction in adverse events. Pulmonary hemorrhage is a rare but potentially lethal complication of antithrombotic and antiplatelet therapy. We analyzed the incidence of spontaneous pulmonary hemorrhage following the use of platelet GP IIb/IIIa inhibitors.


METHODS
The medical records of 1,020 consecutive patients who received GP IIb/IIIa inhibitors and underwent PCI at our institution between August 1997 and December 1999 were reviewed.


RESULTS
Diffuse pulmonary hemorrhage developed in 7 patients (0.68%), two of whom died. Five of 7 patients with pulmonary hemorrhage had activated clotting times > 250 seconds during the procedure. Activated partial thromboplastin time measured at the time of pulmonary hemorrhage was elevated in all patients (mean, 85 seconds; range, 69 95 seconds). All patients had history of congestive heart failure and had elevated pulmonary capillary wedge pressure and/or left ventricular end-diastolic pressure at the time of the index procedure. Six patients also had evidence of baseline radiographic abnormalities.


CONCLUSIONS
Diffuse pulmonary hemorrhage is a potentially disastrous complication of GP Ilb/Illa antagonists. No specific predictors can be identified, but evidence of pulmonary congestion, baseline pulmonary abnormalities and use of higher heparin dosages may predispose patients to this serious complication.
Ali
Arshad
A
Division of ardiology, St Johns Hospital & Medical Center, Detroit, MI, USA. arshadali@aol.com
Hashem
Mustafa
M
Rosman
Howard S
HS
Kazmouz
Ghassan
G
Gardin
Julius M
JM
Schrieber
Theodore L
TL
D000077284:Abciximab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D000077542:Eptifibatide; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000009:adverse effects; D015994:Incidence; D008171:Lung Diseases / Q000139:chemically induced* / Q000453:epidemiology; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D010455:Peptides / Q000009:adverse effects / Q000037:antagonists & inhibitors; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000009:adverse effects* / Q000037:antagonists & inhibitors*; D011669:Pulmonary Wedge Pressure / Q000187:drug effects; D000077466:Tirofiban; D017211:Treatment Failure; D014443:Tyrosine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000037:antagonists & inhibitors; D017725:Ventricular Pressure / Q000187:drug effects
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; D000077466:Tirofiban; D000077542:Eptifibatide; D000077284:Abciximab