Comparison of two platelet glycoprotein IIb/IIIa inhibitors, eptifibatide and abciximab: outcomes, complications and thrombocytopenia during percutaneous coronary intervention.
BACKGROUND
Platelet glycoprotein IIb/IIIa inhibitors have significantly reduced the incidence of 30-day ischemic events during percutaneous coronary interventions (PCI). However, each of the three currently available agents has different pharmacological characteristics, safety, efficacy and costs. There has not been a direct comparison between eptifibatide and abciximab in the rates of major adverse cardiac events, major complications and thrombocytopenia.


METHODS
A total of 642 consecutive patients underwent PCI at our institution between January 2000 and December 2001 and were treated with either eptifibatide (n = 342) or abciximab (n = 300) during the procedure. The selection of the IIb/IIIa inhibitor was arbitrary and left to the discretion of the operator. Complete blood counts were performed by routine protocol on all patients 2 and 4 hours after initiation of the drug. We analyzed the in-hospital clinical outcomes and the incidence of thrombocytopenia in this cohort.


RESULTS
Baseline clinical and angiographic characteristics and concomitant drug treatment were similar between the 2 groups, except for a higher incidence of diabetes in the eptifibatide group. The rates of in-hospital death (1.2% eptifibatide group versus 1.0% abciximab group; p = 0.7), stroke (0% for both groups), target vessel revascularization (1.2% eptifibatide group versus 1.0% abciximab group; p = 0.8) and major bleeding complications (1.7% eptifibatide group versus 0.7% abciximab group; p = 0.2) were similar between the 2 groups. Thrombocytopenia was more frequent in the abciximab-treated patients (6%, versus 0% in the eptifibatide group; p < 0.001), including 5 patients who developed profound thrombocytopenia (< 20,000 cells/mm3).


CONCLUSIONS
Both agents, eptifibatide and abciximab, proved to have the same rates of in-hospital major adverse cardiac events, bleeding and vascular complications. Abciximab therapy was associated with a significantly higher incidence of thrombocytopenia within 4 hours of drug initiation, which prompted immediate drug discontinuation, but was not associated with increased risk of bleeding, vascular or other complications.
Suleiman
Mahmoud
M
Division of Invasive Cardiology, Department of Cardiology, Rambam Medical Center, Haifa-31096, Israel. gruberg67@hotmail.com
Gruberg
Luis
L
Hammerman
Haim
H
Aronson
Doron
D
Halabi
Majdi
M
Goldberg
Alexander
A
Grenadier
Ehud
E
Boulus
Monther
M
Markiewicz
Walter
W
Beyar
Rafael
R
D000077284:Abciximab; D000368:Aged; D000789:Angina, Unstable / Q000453:epidemiology / Q000209:etiology; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000379:methods*; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000627:therapeutic use; D016009:Chi-Square Distribution; D015331:Cohort Studies; D023903:Coronary Restenosis / Q000453:epidemiology / Q000209:etiology; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D000077542:Eptifibatide; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000009:adverse effects* / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000009:adverse effects* / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011336:Probability; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000453:epidemiology; D016896:Treatment Outcome
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077542:Eptifibatide; D000077284:Abciximab