Alveolar hemorrhage as a complication of treatment with abciximab

Study objective: The use of abciximab, a chimeric monoclonal antibody Fab f ragment specific for platelet glycoprotein IIb/IIIa receptors, is associate d with improved outcome after angioplasty and stent placement. Major compli cations include bleeding, but pulmonary hemorrhage has been reported rarely . This study was done to identify patients with pulmonary hemorrhage follow ing abciximab infusion and to define, if possible, any specific risk factor s, Design: Retrospective review of institutional coronary angiography and bron choscopy databases to identify patients who received abciximab and develope d pulmonary hemorrhage. Setting: Tertiary-care teaching hospital. Patients: All patients who underwent coronary angiography and received abci ximab between June 1995 and March 2000, Intervention: None. Measurements and results: Seven of 2,553 patients (0.27%) had documented se , cre pulmonary hemorrhage associated with chest radiographic abnormalities , impaired oxygenation, and the need for blood product transfusions. The in itial symptom was hemoptysis in four of the seven patients. There were two early deaths and one late death. No cases of pulmonary hemorrhage were iden tified in 5,412 patients who underwent coronary procedures without abcixima b infusion. No other risk factors predicting hemorrhage were identified. Conclusions: Severe pulmonary hemorrhage is a complication of abciximab use . Although hemoptysis is an important alerting symptom, it may not he prese nt initially and tile diagnosis may be missed or considered late, with the potential for inappropriate treatment until the diagnosis is established. L esser degrees of bleeding are potentially easily missed, and this report sh ould alert physicians to this complication so that it can be considered ear ly in the evaluation of patients presenting with pulmonary events after abc iximab use.