Chest
Volume 120, Issue 1, July 2001, Pages 126-131
Journal home page for Chest

Clinical Investigations
Cardiology
Alveolar Hemorrhage as a Complication of Treatment With Abciximab

https://doi.org/10.1378/chest.120.1.126Get rights and content

Study objective

The use of abciximab, a chimericmonoclonal antibody Fab fragment specific for platelet glycoprotein IIb/IIIa receptors, is associated with improved outcome afterangioplasty and stent placement. Major complications include bleeding, but pulmonary hemorrhage has been reported rarely. This study was doneto identify patients with pulmonary hemorrhage following abciximabinfusion and to define, if possible, any specific risk factors.

Design

Retrospective review of institutional coronaryangiography and bronchoscopy databases to identify patients whoreceived abciximab and developed pulmonary hemorrhage.

Setting

Tertiary-care teaching hospital.

Patients

All patients who underwent coronary angiographyand received abciximab between June 1995 and March 2000.

Intervention

None.

Measurements andresults

Seven of 2,553 patients (0.27%) had documented severepulmonary hemorrhage associated with chest radiographic abnormalities, impaired oxygenation, and the need for blood product transfusions. Theinitial symptom was hemoptysis in four of the seven patients. Therewere two early deaths and one late death. No cases of pulmonaryhemorrhage were identified in 5,412 patients who underwent coronaryprocedures without abciximab infusion. No other risk factors predictinghemorrhage were identified.

Conclusions

Severepulmonary hemorrhage is a complication of abciximab use. Althoughhemoptysis is an important alerting symptom, it may not be presentinitially and the diagnosis may be missed or considered late, with thepotential for inappropriate treatment until the diagnosis isestablished. Lesser degrees of bleeding are potentially easily missed, and this report should alert physicians to this complication so that itcan be considered early in the evaluation of patients presenting withpulmonary events after abciximab use.

Section snippets

Materials and Methods

The records of the cardiac catheterization laboratory at Mayo Clinic, Rochester were searched electronically to identify all patients who received abciximab during the study period. We identified 2,553 such patients whose records were then further examined for a diagnosis of either alveolar hemorrhage or occurrence of hemoptysis, and by cross-checking these with records of bronchoscopic procedures during this period. This was supplemented by an informal survey of staff and Fellows in the

Results

Seven patients (six men; mean age, 75 years; range, 67 to 83 years) of the 2,553 patients (0.27%) who received abciximab were identified with proven or highly probable alveolar hemorrhage. Table 1summarizes their demographic and clinical data. No episodes of pulmonary hemorrhage were identified in the 5,412 patients who had not received abciximab, a clinically and statistically significant difference (χ2, 11.89; Fisher's Exact Test, p = 0.0003).

The use of abciximab occurred in the setting of

Discussion

The use of abciximab during and after coronary angioplasty and elective stent placement has been associated with significantly improved patient outcomes, particularly a reduction in periprocedural myocardial infarction and less need for urgent reintervention. The most significant and frequent complication has been bleeding, most frequently at the vascular access site, but also from the GI tract and only rarely intracranially.2,5 The frequency and severity of these bleeding complications appear

References (10)

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