Glycoprotein IIb/IIIa receptor inhibition with abciximab during percutaneous coronary interventions increases the risk of bleeding in patients with impaired renal function.

Abstract

OBJECTIVE:

Whether patients with renal insufficiency (RI) undergoing percutaneous coronary interventions (PCI) benefit from abciximab added to clopidogrel plus aspirin is unknown.

METHODS:

The study included 2,159 patients with coronary artery disease undergoing elective PCI. RI was assessed using glomerular filtration rate (GFR) cutoff values: moderate-to-severe RI (GFR <or=60 ml/min), mild RI (GFR >60 to <or=90 ml/min) and no RI (GFR >90 ml/min). The 30-day incidence of major adverse cardiac events (MACE) and bleeding were the primary outcome analyses.

RESULTS:

In patients with moderate-to-severe RI, mild RI and no RI, MACE occurred in 5.2, 5 and 2.9%, respectively, in the abciximab group (p = 0.14) and in 4.2, 3.8 and 4.0%, respectively, in the placebo group (p = 0.96). In the abciximab group, bleeding complications occurred in 8.9% of patients with moderate-to-severe RI, in 2.0% with mild RI and in 2.1% with no RI (p < 0.001). Multivariable analysis identified GFR as an independent correlate of MACE (p = 0.03) and bleeding (p = 0.001) with a trend for an interaction between GFR and abciximab regarding major bleeding (p = 0.22).

CONCLUSIONS:

In patients with RI undergoing PCI, adding abciximab to clopidogrel plus aspirin increases the risk of bleeding without benefit in reducing the risk of ischemic complications within the first 30 days.

• Authors: Tobias Pinkau, Gjin Ndrepepa, Adnan Kastrati, Johannes F E Mann, Stefanie Schulz, Julinda Mehilli, Albert Schömig
• Journal: Cardiology (Cardiology) Vol. 111 Issue 4 Pg. 247-53 ( 2008) ISSN: 1421-9751 [Electronic] Switzerland
• PMID: 18434733 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright 2008 S. Karger AG, Basel.

Chemical References

• Antibodies, Monoclonal
• Immunoglobulin Fab Fragments
• Platelet Aggregation Inhibitors
• Platelet Glycoprotein GPIIb-IIIa Complex
• Clopidogrel
• Ticlopidine
• Aspirin
• Abciximab

Topics

• Abciximab
• Aged
• Aged, 80 and over
• Angioplasty, Balloon, Coronary
• Antibodies, Monoclonal (administration & dosage, adverse effects)
• Aspirin (administration & dosage, adverse effects)
• Clopidogrel
• Coronary Artery Disease (complications, drug therapy, mortality, therapy)
• Drug Therapy, Combination
• Female
• Germany
• Glomerular Filtration Rate
• Hemorrhage (chemically induced)
• Humans
• Immunoglobulin Fab Fragments (administration & dosage, adverse effects)
• Male
• Middle Aged
• Multivariate Analysis
• Platelet Aggregation Inhibitors (administration & dosage, adverse effects)
• Platelet Glycoprotein GPIIb-IIIa Complex (antagonists & inhibitors)
• Renal Insufficiency (complications, mortality)
• Retrospective Studies
• Surveys and Questionnaires
• Survival Analysis
• Ticlopidine (administration & dosage, adverse effects, analogs & derivatives)