Bleeding risks with abciximab after full-dose thrombolysis in rescue or urgent angioplasty for acute myocardial infarction

Background The bleeding risk associated with platelet glycoprotein IIb/IIIa inhibition in patients undergoing percutaneous transluminal coronary angio plasty (PTCA) after full-dose thrombolysis for acute myocardial infarction [AM[) is unclear. We examined the risk and predictors of bleeding complicat ions in patients with AMI who received abciximab during rescue or urgent PT CA after full-dose thrombolytic therapy. Methods A multicenter retrospective cohort of 147 consecutive patients who underwent PTCA within 48 hours after full-dose thrombolysis for AMI was stu died. Bleeding events (major, minor, nuisance) from the onset of AMI to dis charge were compared between those who received abciximab (n = 57) and thos e who did not(n = 90). Results Baseline clinical characteristics were similar between the two grou ps. Despite lower doses of procedural heparin, the incidence of non-coronar y artery bypass graft-related major and minor bleeding was higher in the ab ciximab group than in controls (63% vs 39%, P = .004). Although the risk of major bleeding was 4-fold with abciximab (12% vs 3%, P = .04), only one in tracranial and one fatal bleeding event occurred. Multivariable regression identified abciximab therapy as the most powerful independent predictor of combined major and minor bleeding, with a hazard risk ratio of 1.9 (P = .04 ). Conclusions In the setting of rescue or urgent PTCA within 48 hours after f ull-dose thrombolytic therapy after AMI, major and particularly minor bleed ing were frequently encountered. The adjunctive use of abciximab increased these bleeding risks by approximately 2-fold.