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Abciximab and fatal pulmonary hemorrhage

      Abciximab, a platelet glycoprotein IIb/IIIa receptor blocker, is a well-known agent in percutaneous coronary intervention because of its antiplatelet, antithrombotic effects, which allow for good outcome. Major bleeding is a well-recognized complication of abciximab therapy, and pulmonary hemorrhage, although infrequent, is a serious, under-recognized, and often fatal complication. We describe a case of fatal pulmonary hemorrhage in a young woman who presented with acute myocardial infarction and cardiogenic shock and was treated with abciximab in conjunction with percutaneous coronary intervention. The possibility of diffuse pulmonary hemorrhage should be strongly suspected in the presence of hypoxemia, infiltrates on chest radiography, and a decrease in hemoglobin. Awareness about this complication of abciximab therapy on the part of physicians and health care professionals is strongly warranted. Therapy that may be used if diagnosis is promptly made includes bronchoscopic-guided balloon tamponade or iced saline lavage. These therapeutic interventions are still in the developmental stage, and to date there are no trials to document their efficacy and survival benefit.
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      References

        • EPIC Investigators
        Use of monoclonal antibody directed against platelet glycoprotein IIb/IIIa receptor in high-risk coronary angioplasty.
        N Engl J Med. 1994; 330: 956-961
        • Montalescot G.
        • Barragan P.
        • Wittenberg O.
        • et al.
        • ADMIRAL Investigators
        platelet glycoprotein IIb/IIIa inhibition with coronary stenting for acute myocardial infarction.
        N Engl J Med. 2001; 344: 1895-1903
        • Topol J.E.
        • Califf M.R.
        • Weisman F.H.
        • et al.
        Randomized trial of coronary intervention with antibody against platelet IIb/IIIa integrin for reduction of clinical restenosis: results at six months.
        Lancet. 1994; 343 (on behalf of the EPIC investigators): 881-886
        • Chan A.W.
        • Chew D.P.
        • Bhatt D.L.
        • Moliterno D.J.
        • Topol E.J.
        • Ellis S.G.
        Long term mortality benefit with the combination of stents and abciximab for cardiogenic shock complicating acute myocardial infarction.
        Am J Cardiol. 2002; 89: 132-136
        • Brown D.L.
        Deaths associated with platelet glycoprotein IIb/IIIa inhibitor treatment.
        Heart. 2003; 89: 535-537
        • Cohen S.A.
        • Effron M.B.
        Abciximab and alveolar hemorrhage.
        N Engl J Med. 1998; 339: 1861-1863
        • Sitges M.
        • Villa F.P.
        Massive pulmonary hemorrhage in a patient treated with a platelet glycoprotein IIb/IIIa inhibitor.
        Int J Cardiol. 1997; 62: 269-271
        • Aguirre F.V.
        • Topol E.J.
        • Ferguson J.J.
        • et al.
        • EPIC Investigators
        Bleeding complications with the chimeric antibody to platelet glycoprotein IIb/IIIa integrin in patients undergoing percutaneous coronary intervention.
        Circulation. 1995; 91: 2882-2890
        • Khanlou H.
        • Tsiodras S.
        • Eiger G.
        • et al.
        Fatal alveolar hemorrhage and abciximab (ReoPro) therapy for acute myocardial infarction.
        Cathet Cardiovasc Diagn. 1998; 44: 313-331
        • Ali A.
        • Patil S.
        • Grady K.J.
        • Schreiber T.L.
        Diffuse alveolar hemorrhage following administration of tirofiban or abciximab: a nemesis of platelet glycoprotein IIb/IIIa inhibitors.
        Catheter Cardiovasc Interv. 2000; 49: 181-184
        • Kalra S.
        • Bell M.R.
        • Rihal C.S.
        Alveolar hemorrhage as a complication of treatment with abciximab.
        Chest. 2001; 120: 126-131
        • EPILOG Investigators
        Platelet glycoprotein IIb/IIIa receptor blockade and low dose heparin during percutaneous coronary revascularization.
        N Engl J Med. 1997; 336: 1689-1696
        • Kilaru P.K.
        • Schweiger M.J.
        • Kozman H.A.
        • Weil T.R.
        Diffuse alveolar hemorrhage after clopidogrel use.
        J Invasive Cardiol. 2001; 13: 535-537
        • Amanullah S.
        • Mina B.
        • Rogers M.
        Iced saline bronchoalveolar lavage—a potential therapeutic option for pulmonary hemorrhage after percutaneous coronary intervention (PCI).
        Chest. 2004; 126: 926S