Abciximab resulted in a higher rate of thrombocytopenia compared to tirofiban (2.4% vs 0.5%, P<0.001) during coronary stenting, which was associated with more bleeding and ischemic events.
RCT
Does abciximab compared to tirofiban increase the risk of thrombocytopenia, and is it associated with adverse outcomes in patients undergoing coronary stenting?
Abciximab carries a higher risk of thrombocytopenia than tirofiban during coronary stenting, and this complication is strongly associated with increased bleeding, transfusions, and ischemic events.
Absolute Event Rate: 2.4% vs 0.5%
p-value: p=<0.001
BACKGROUND: Thrombocytopenia is a possible complication of treatment with glycoprotein (GP) IIb/IIIa antagonists during percutaneous coronary interventions, but it is not clear whether different GP IIb/IIIa inhibitors carry a different risk of thrombocytopenia, and its relation to clinical outcome is unknown. METHODS AND RESULTS: We analyzed data from the Do Tirofiban and Reopro Give Similar Efficacy Outcomes (TARGET) study, which compared the safety and efficacy of abciximab and tirofiban in patients undergoing coronary stenting. Platelets were measured at baseline and 6 and 24 hours after the beginning of treatment. Thrombocytopenia (nadir platelet count or =0.8 mg/dL (OR, 3.8; 95% CI, 1.7 to 8.8), previous transient ischemic attack (OR, 3.2; 95% CI, 1.4 to 7.6), female gender (OR, 1.9; 95% CI, 1.2 to 3.1), and history of peripheral vascular disease (OR, 1.78; 95% CI, 1.0 to 3.1). Severe bleeding occurred more frequently in patients with thrombocytopenia (5.1% versus 0.7%, P=0.001), who also more frequently received blood transfusions (6.1% versus 1.4%, P=0.001). At the 30-day follow-up, 2.0% of patients with thrombocytopenia and 0.4% of those without (P=0.022) had died; myocardial infarction occurred in 9.13% versus 6.11% (P=NS); and target vessel revascularization occurred in 6.07% versus 0.60% (P<0.001). CONCLUSIONS: During coronary stenting, abciximab and other risk factors are independently associated with thrombocytopenia. Regardless of the cause, thrombocytopenia is associated with more ischemic events, bleedings, and transfusions.
Merlini et al. (2004) conducted an RCT in Coronary stenting. Abciximab vs. Tirofiban was evaluated on Thrombocytopenia (nadir platelet count <100x10(9) cells/L) (p=<0.001). Abciximab resulted in a higher rate of thrombocytopenia compared to tirofiban (2.4% vs 0.5%, P<0.001) during coronary stenting, which was associated with more bleeding and ischemic events.