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Anti‐GPIIbIIIa induced thrombocytopenia Volume 10, issue 1, Janvier-Février 2004

Authors
Centre de pharmacovigilance Service d‘hématologie biologique A, Hôpital européen Georges Pompidou, 20, rue Leblanc, 75908 Paris Cedex 15, France

The platelet glycoprotein (GP) IIbIIIa receptor antagonists (abciximab, eptifibatide, tirofiban) are very efficient antiaggregant drugs used to decrease the ischemic complications of percutaneous coronary interventions. They are also used in the medical treatment of acute coronary syndromes. Severe thrombocytopenia (< 50 G\L) is a potentially serious complication of these treatments, which most often occurs very soon after starting drug infusion (nadir between 2 and 31 h). In 4 large clinical trials (Capture, Epic, Epilog, Epistent), abciximab use was significantly associated with an increased risk (OR about 2) of thrombocytopenia (< 100 G\L). Profound thrombocytopenia (< 20 G\L) also occurred. In a meta‐analysis which combines the results of 5 large clinical trials (Impact II, Prism, Prism Plus, Pursuit, Restore), tirofiban and eptifibatide treatments did not significantly increase the risk of thrombocytopenia. However, thrombocytopenia occured in several patients. Clinical events associated with GPIIbIIIa receptor antagonists induced thrombocytopenia were described with details in case reports. We analyzed the clinical data from 40 case reports (26 concerning abciximab, 10 eptifibatide and 4 tirofiban‐induced thrombocytopenia). Bleeding events were rare. However, profound thrombocytopenia led to fatal intra‐cranial bleeding in 2 patients treated with abciximab and to severe bleeding in one patient treated with tirofiban. The pathogenesis of anti‐GPIIbIIIa‐associated thrombocytopenia is not fully understood. Naturally occuring antibodies or antibodies developed after administration of the drug could be responsible for thrombocytopenia. The identification of the epitopes recognized by these antibodies is in progress.