ABCIXIMAB AND EXCESSIVE BLEEDING IN PATIENTS UNDERGOING EMERGENCY CARDIAC OPERATIONS

Background. Abciximab (ReoPro; Eli Lilly and Co, Indianapolis, IN) is a monoclonal antibody that binds to the platelet glycoprotein IIb/IIIa receptor and produces powerful inhibition of platelet function. Clini cal trials of abciximab in patients undergoing coronary angioplasty ha ve demonstrated a reduction in thrombotic complications and have encou raged the widespread use of this agent. We have observed a substantial incidence of excessive bleeding among patients who receive abciximab and subsequently require emergency cardiac operations. Methods. The re cords of II consecutive patients who required emergency cardiac operat ions after administration of abciximab and failed angioplasty or stent placement were reviewed. Results. The interval from the cessation of abciximab administration to operation was critical in determining the degree of coagulopathy after cardiopulmonary bypass. The median values for postoperative chest drainage (1,300 versus 400 mL; p < 0.01), pac ked red blood cells transfused (6 versus 0 U; p = 0.02), platelets tra nsfused (20 versus 0 packs; p = 0.02), and maximum activated clotting time (800 versus 528 seconds; p = 0.01) all were significantly greater in the early group (cardiac operation < 12 hours after abciximab admi nistration; n = 6) compared with the late (cardiac operation > 12 hour s after abciximab administration; n = 5) group. Conclusions. This repo rt suggests that the antiplatelet agent abciximab is associated with s ubstantial bleeding when it is administered within 12 hours of operati on. (C) 1998 by The Society of Thoracic Surgeons.