A prospective analysis of complications related to the use of glycoprotein IIb/IIIa inhibitors in acute coronary syndromes

Background

Glycoprotein IIb/IIIa inhibitors (GPI) are potent antiplatelet agents, with promising results in the treatment of acute coronary syndromes, independently of reperfusion strategies, but with a concerning hemorrhagic profile.

Objectives

To analyze an initial experience with the use of abciximab and tirofiban associated to percutaneous coronary interventions (PCI) and their effect on morbidity and mortality, and the relationship with technical, demographic and therapeutic variables.

Materials and method

We studied 70 patients (65 abciximab and five tirofiban). Forty-seven men (mean age 62.7 ± 12.9 years) and 23 women (68.8 ± 9.7 years; P = 0.049) were analyzed according to diagnosis, risk factors, hemoglobin and platelet count, bleeding, duration of sheath maintenance and mortality.

Results

Diagnoses were acute myocardial infarction (AMI; 42 patients), unstable angina/non-Q-wave AMI (27 patients) and stable angina (1 patient), with seven deaths with a higher mean age (77.4 ± 4.0 versus 63.6 ± 12.3; P < 0.001). We observed strong correlations between mortality and mean hemoglobin levels (P < 0.00001) and mean platelet count (P = 0.013) after PCI. There were 25 hematomas that correlated with longer time of sheath maintenance (P = 0.009). Other bleeding complications were retroperitoneal hematoma (two patients), hematuria (one), pseudoaneurysm (one), oral bleeding (three), hematemesis (two), hemoptysis (two) and hemopericardium (two). Patients who died had ≥ 2 vessels disease, left ventricle dysfunction, five patients used intra-aortic balloon counterpulsation and six received hemo-transfusion.

Conclusion

Higher morbidity correlated with increased time of sheath maintenance and higher mortality correlated with hemoglobin and platelet depletion, although this could be due to more bleedings induced by GPI or due to the severity of clinical presentation.