Thrombocytopenia complicating treatment with intravenous glycoprotein IIb/IIIa receptor inhibitors: A pooled analysis

Background Despite the increasingly prevalent role of platelet glycoprotein (GP) IIb/IIIa receptor inhibitors in acute coronary syndromes and percutan eous coronary interventions, the incidence and clinical relevance of thromb ocytopenia occurring with their use remain unclear, Methods we identified 8 placebo-controlled, randomized, large trials of GP IIb/IIIa receptor inhibitors reporting the incidence of thrombocytopenia, g rouped by severity. The clinical courses of 42 patients with GP IIb/IIIa-re lated thrombocytopenia in these studies and other case reports were reviewe d for bleeding complications, Results Abciximab increased mild thrombocytopenia compared with placebo (4. 2% vs 2.0%; P <.001; odds ratio 2.14) and increased severe thrombocytopenia compared with placebo (1.0% vs 0.4%; P =.01; odds ratio 2.48). Small-molec ule IIb/IIIa inhibitors did not significantly increase mild or severe throm bocytopenia compared with placebo. Mild thrombocytopenia occurred more freq uently in acute coronary syndrome trials than in coronary intervention tria ls, even in patients not receiving any IIb/IIIa inhibitors. No major bleedi ng sequelae were reported in 23 patients with severe thrombocytopenia or in 19 patients with profound thrombocytopenia, Conclusions Abciximab, but not eptifibatide or tirofiban, increases the inc idence of thrombocytopenia compared with placebo in patients also treated w ith heparin. Thrombocytopenia associated with GP IIb/IIIa inhibition does n ot routinely lead to severe bleeding complications.