Delayed Immune-Mediated Thrombocytopenia After Re-exposure to Abciximab Therapy

doi:10.1016/j.cjca.2011.05.011

Canadian Journal of Cardiology

Volume 27, Issue 6, November–December 2011, Pages 869.e13-869.e14

https://doi.org/10.1016/j.cjca.2011.05.011 Get rights and content

Abstract

Abciximab is a potent antiplatelet agent that is increasingly being used to prevent ischemic complications of percutaneous coronary revascularization. Thrombocytopenia, including acute profound thrombocytopenia, has been reported to occur with this agent, but usually within 1 to 2 days of exposure. We report the case of a woman aged 68 years who presented with profound delayed thrombocytopenia 9 days after a second exposure to abciximab. She was treated successfully with intravenous immunoglobulin with complete resolution of the thrombocytopenia and no subsequent recurrences.

Résumé

L'abciximab est un agent antiplaquettaire puissant qui est de plus en plus utilisé pour prévenir les complications ischémiques de la revascularisation coronarienne percutanée. La thrombocytopénie, incluant la thrombocytopénie profonde aiguë, a été rapportée avec cet agent, mais habituellement après 1 à 2 jours d'exposition. Nous rapportons le cas d'une femme âgée de 68 ans qui a présenté une thrombocytopénie retardée profonde 9 jours après une deuxième exposition à l'abciximab. Elle a été traitée avec succès par immunoglobulines intraveineuses avec résolution complète de la thrombocytopénie et aucune récurrence subséquente.

Section snippets

Case Report

We report the case of a woman, aged 68 years, with delayed, profound thrombocytopenia after a second exposure to abciximab. She has a history of adult-onset diabetes mellitus and coronary artery disease, with a previous angioplasty and stent placement, requiring abciximab therapy, in 2006. She did not develop thrombocytopenia at the time. Most recently, she underwent cardiac catheterization with a second angioplasty and placement of a drug-eluting stent (Taxus). During this recent angioplasty,

Discussion

Review of the literature documenting abciximab-induced acute thrombocytopenia demonstrates that it generally occurs within the first few hours of infusion, but there have been reports of delayed abciximab-induced thrombocytopenia that occurred following hospital discharge. Abciximab is a large immune protein (47,455 g/mol). It presents a target for the patient's immune system as it is a xeno protein from a mouse. Therefore it is much more likely to induce immune-mediated adverse effects than is

Disclosures

The authors have no conflicts of interest to disclose.

References (5)

S.D. Berkowitz et al.
Occurrence and clinical significance of thrombocytopenia in a population undergoing high-risk percutaneous coronary revascularization: Evaluation of c7E3 for the Prevention of Ischemic Complications (EPIC) study group
J Am Coll Cardiol
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G.K. Lo et al.
Evaluation of pretest clinical score (4 T's) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings
J Thromb Haemost
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There are more references available in the full text version of this article.

Cited by (1)

Delayed thrombocytopenia following administration of abciximab: Pharmacovigilance survey and literature review
2021, Therapies
Citation Excerpt :
One of them gets red blood cells in addition and one other received corticosteroid. In the literature, 42 cases of ABX-induced delayed thrombocytopenia were published [3–18] and summarised in Table 3. Mean age was 61.8 ± 10.7 years and 66.6% of patients were male.
Abciximab (ABX) is used for acute coronary syndrome and unstable angina. Thrombocytopenia is a frequent adverse effect described as occurring in the first 24 hours. The aim of this study was to evaluate, in a context of pharmacovigilance survey, the occurrence of delayed thrombocytopenia following ABX infusion in pharmacovigilance database reports and in the literature.
Individual case safety reports (ICSRs) of delayed thrombocytopenia–between 3 and 30 days - with ABX presented as a single suspect were selected in VigiBase®, the WHO global database of ICSRs. The French cases were then extracted from the French national pharmacovigilance database. In addition, a literature review of published cases was performed using PubMed.
Among the 84 ICSRs selected from VigiBase®, 43 were also reported in the FPVD. Mean age was 60.1 ± 12.3 years with a majority of male patients (77.4%). The average time to onset (TTO) was 8.9 ± 5.2 days. Thrombocytopenia regressed in 5.1 ± 2.7 days. Haemorrhagic complications were reported in 15% of ICSRs. In the French cases, the median nadir of platelet count was 28 × 10⁹/L (range 1-110) with a majority of grade 4 thrombocytopenia (39.5%). The literature review identified 42 cases and provided additional information on administered therapies, which include platelet units, corticosteroids, and IV immunoglobulins. GPIIb/IIIa-ABX complex antibodies were described in 26 published cases.
Delayed thrombocytopenia, probably due to immune reaction, is a possible life-threatening adverse effect of ABX with a mean TTO of 9 days, supporting the recommendation of a platelet count monitoring during at least two weeks. This recommendation was added to the abcximab SmPC in 2019.

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Canadian Journal of Cardiology

Case reportDelayed Immune-Mediated Thrombocytopenia After Re-exposure to Abciximab Therapy

Abstract

Résumé

Section snippets

Case Report

Discussion

Disclosures

Occurrence and clinical significance of thrombocytopenia in a population undergoing high-risk percutaneous coronary revascularization: Evaluation of c7E3 for the Prevention of Ischemic Complications (EPIC) study group

J Am Coll Cardiol

Evaluation of pretest clinical score (4 T's) for the diagnosis of heparin-induced thrombocytopenia in two clinical settings

J Thromb Haemost

Delayed thrombocytopenia following administration of abciximab: Pharmacovigilance survey and literature review

Case report
Delayed Immune-Mediated Thrombocytopenia After Re-exposure to Abciximab Therapy