Occurrence and clinical significance of thrombocytopeni in population undergoing high-risk percutaneous coronary revascularization

Objectives. This study sought to determine the frequency of thrombocytopeni and its relation with clinical outcomes in high risk patients undergoing percutaneous coronary revascularization who received either the platelet glycoprotein (GP) IIb/III receptor antagonist abciximab (ReoPro, c7E3 Fab) or conventional therapy. Background. The development of thrombocytopeni on exposure to GPIIb/III antagonists threatens the utility and economic viability of this drug class for patients with vascular disease. Methods. We analyzed dat from the Evaluation of c7E3 for the Prevention of Ischemic Complications trial (EPIC), 2,099-patient, randomized trial of placebo, abciximab bolus or abciximab bolus plus 12-h infusion during high-risk coronary revascularization. Results. Thrombocytopeni (nadir platelet count <100 × 109/liter) developed in 81 patients (3.9%) during their hospital stay, with 19 (0.9%) developing severe (<50 × 109/liter) thrombocytopenia. Both thrombocytopeni and severe thrombocytopeni were more frequent in the bolus-plus-infusion arm (5.2% and 1.6%, respectively) than in the bolus-only and placebo arms combined (p = 0.020 and p = 0.025, respectively). Acute profound thrombocytopeni developed in two patients in the bolus-plus-infusion arm. Patients with thrombocytopeni experienced more unfavorable clinical outcomes than those who did not develop thrombocytopenia, regardless of treatment assignment, but those with thrombocytopeni who received abciximab had fewer worse outcomes at 30 days. Multivariable logistic modeling revealed lower baseline platelet count, older age and lighter weight to be important predictors of thrombocytopenia. In logistic regression model, bolus-plus-infusion treatment was significant predictor of thrombocytopeni (p = 0.016) and remained so after adjustment for procedures and baseline risk factors (p = 0.0077). Conclusions. Thrombocytopeni was associated with adverse clinical outcomes and excessive bleeding, but patients receiving abciximab fared better than those receiving placebo.