Study objective: The use of abciximab, a chimeric
monoclonal antibody Fab fragment specific for platelet glycoprotein
IIb/IIIa receptors, is associated with improved outcome after
angioplasty and stent placement. Major complications include bleeding,
but pulmonary hemorrhage has been reported rarely. This study was done
to identify patients with pulmonary hemorrhage following abciximab
infusion and to define, if possible, any specific risk factors.
Design: Retrospective review of institutional coronary
angiography and bronchoscopy databases to identify patients who
received abciximab and developed pulmonary hemorrhage.
Setting: Tertiary-care teaching hospital.
Patients: All patients who underwent coronary angiography
and received abciximab between June 1995 and March 2000.
results: Seven of 2,553 patients (0.27%) had documented severe
pulmonary hemorrhage associated with chest radiographic abnormalities,
impaired oxygenation, and the need for blood product transfusions. The
initial symptom was hemoptysis in four of the seven patients. There
were two early deaths and one late death. No cases of pulmonary
hemorrhage were identified in 5,412 patients who underwent coronary
procedures without abciximab infusion. No other risk factors predicting
hemorrhage were identified.
pulmonary hemorrhage is a complication of abciximab use. Although
hemoptysis is an important alerting symptom, it may not be present
initially and the diagnosis may be missed or considered late, with the
potential for inappropriate treatment until the diagnosis is
established. Lesser degrees of bleeding are potentially easily missed,
and this report should alert physicians to this complication so that it
can be considered early in the evaluation of patients presenting with
pulmonary events after abciximab use.