VASCULAR ACCESS SITE COMPLICATIONS AFTER PERCUTANEOUS CORONARY INTERVENTION WITH ABCIXIMAB IN THE EVALUATION OF C7E3 FOR THE PREVENTION OF ISCHEMIC COMPLICATIONS (EPIC) TRIAL

Thrombolytic therapy or intense anticoagulation during percutaneous tr ansluminal coronary revascularization (PTCR) increases the risk of vas cular access site complications. This study evaluated the association of abciximab, a glycoprotein IIb/IIIa receptor blocker, with vascular access site complications after PTCR, Of 2,058 patients who underwent PTCR in the Evaluation of c7E3 for the Prevention of Ischemic Complica tions (EPIC) trial, major vascular access site bleeding (a drop in hem atocrit >15%), minor vascular access site bleeding (>10% drop), or sur gical repair of the access site occurred in 5%, 12%, and 1.4% of all p atients, respectively. Minor and/or major bleeding or surgery occurred in 21.8% of abciximab patients, compared with 9.1% of placebo patient s (p <0.001). Logistic regression analysis identified these predictors of minor and/or major bleeding and/or surgical repair, in descending order of importance: abciximab therapy, acute myocardial infarction at enrollment, high baseline hematocrit, time in catheterization laborat ory, heavier weight, female gender, maximum in catherization laborator y activated clotting time, sheath size, and age (all p <0.05). Vascula r access site complications increased median post-PTCR length of stay from 2 days (no bleeding) to 3 days (minor bleeding) and 6 days (major bleeding), Site-to-site variation in vascular access site complicatio ns varied six fold. Analyses of subsequent studies of PTCR with abcixi mab will determine whether discontinuing heparin and removing sheaths early after PTCR reduces the risk of vascular access site complication s. (C) 1998 by Excerpta Medica, Inc.