title: Thrombocytopenia caused by abciximab or tirofiban and its association with clinical outcome in patients undergoing coronary stenting.
abstract: BACKGROUND
  Thrombocytopenia is a possible complication of treatment with glycoprotein (GP) IIb/IIIa antagonists during percutaneous coronary interventions, but it is not clear whether different GP IIb/IIIa inhibitors carry a different risk of thrombocytopenia, and its relation to clinical outcome is unknown.
  
  
  RESULTS
  We analyzed data from the Do Tirofiban and Reopro Give Similar Efficacy Outcomes (TARGET) study, which compared the safety and efficacy of abciximab and tirofiban in patients undergoing coronary stenting. Platelets were measured at baseline and 6 and 24 hours after the beginning of treatment. Thrombocytopenia (nadir platelet count <100x10(9) cells/L) developed in 2.4% of patients treated with abciximab and 0.5% of those treated with tirofiban (P<0.001). The variables independently associated with thrombocytopenia were treatment with abciximab within the previous 6 months (OR, 4.4; 95% CI, 1.7 to 11.2), baseline creatinine levels of > or =0.8 mg/dL (OR, 3.8; 95% CI, 1.7 to 8.8), previous transient ischemic attack (OR, 3.2; 95% CI, 1.4 to 7.6), female gender (OR, 1.9; 95% CI, 1.2 to 3.1), and history of peripheral vascular disease (OR, 1.78; 95% CI, 1.0 to 3.1). Severe bleeding occurred more frequently in patients with thrombocytopenia (5.1% versus 0.7%, P=0.001), who also more frequently received blood transfusions (6.1% versus 1.4%, P=0.001). At the 30-day follow-up, 2.0% of patients with thrombocytopenia and 0.4% of those without (P=0.022) had died; myocardial infarction occurred in 9.13% versus 6.11% (P=NS); and target vessel revascularization occurred in 6.07% versus 0.60% (P<0.001).
  
  
  CONCLUSIONS
  During coronary stenting, abciximab and other risk factors are independently associated with thrombocytopenia. Regardless of the cause, thrombocytopenia is associated with more ischemic events, bleedings, and transfusions.
authors.affiliation: Division of Cardiology, Ospedale Niguarda, Piazza Ospedale Maggiore 1, 20162 Milan, Italy. ardis001@planet.it
authors.forename: Piera Angelica
authors.initials: PA
authors.lastname: Merlini
authors.forename: Marco
authors.initials: M
authors.lastname: Rossi
authors.forename: Alberto
authors.initials: A
authors.lastname: Menozzi
authors.forename: Silvia
authors.initials: S
authors.lastname: Buratti
authors.forename: Danielle M
authors.initials: DM
authors.lastname: Brennan
authors.forename: David J
authors.initials: DJ
authors.lastname: Moliterno
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Topol
authors.forename: Diego
authors.initials: D
authors.lastname: Ardissino
mesh_terms: D000077284:Abciximab; D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D001803:Blood Transfusion / Q000706:statistics & numerical data; D003131:Combined Modality Therapy; D023921:Coronary Stenosis / Q000097:blood / Q000188:drug therapy / Q000628:therapy; D004311:Double-Blind Method; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000453:epidemiology; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011446:Prospective Studies; D012307:Risk Factors; D015607:Stents; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000503:physiopathology; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000009:adverse effects* / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; D000077466:Tirofiban; D000077284:Abciximab