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ANTICOAGULATION

Evaluation of Bleeding Complications Associated with Glycoprotein IIb/IIIa Inhibitors

Assistant Professor and Clinical Pharmacy Specialist, School of Pharmacy, Texas Tech University Health Sciences Center, Dallas, TX

Vanessa G Wiesehan, PharmD BCPS

Clinical Pharmacist, Veterans Affairs North Texas Medical Center, Dallas

Reprints: Sara D Brouse PharmD BCPS, School of Pharmacy, Texas Tech University Health Sciences Center, 4500 S. Lancaster Rd., Building 7—119A, Dallas, TX 75216-7167, fax 214/372-5020, sara.brouse{at}ttuhsc.edu

BACKGROUND: Platelet glycoprotein IIb/IIIa inhibitors are used with aspirin and heparin to decrease rates of death, myocardial infarction, and urgent revascularization in patients with acute coronary syndromes.

OBJECTIVE: To determine whether bleeding event rates differed among 3 glycoprotein IIb/IIIa inhibitors prescribed in a high-risk, elderly veteran population and identify risk factors for bleeding.

METHODS: A retrospective chart analysis of patients who received abciximab, eptifibatide, or tirofiban was conducted. ² Analysis evaluated the incidence of bleeding complications, and stepwise regression analysis was utilized to identify bleeding risk factors. Parameters evaluated as possible risk factors for bleeding included age, renal function, weight, heparin and glycoprotein IIb/IIIa inhibitor dosing and infusion duration, concomitant antiplatelet and/or anticoagulant medications or disease states, and baseline hemoglobin, hematocrit, or platelet counts.

RESULTS: Of 348 patients whose charts were reviewed, 79 patients were included. There were 37.9% who received abciximab (n = 30), 30.3% who received eptifibatide (n = 24), and 31.6% who received tirofiban (n = 25). Twenty-one bleeding events not related to coronary artery bypass grafting occurred: only 1 major bleed (tirofiban) and 20 minor bleeds. Bleeding rates were not significantly different between groups: abciximab 30% (n = 9), eptifibatide 21% (n = 5), and tirofiban 28% (n = 7). Significant risk factors for bleeding included patient weight, infusion duration, and baseline platelet count (p = 0.024). Patients who bled received significantly more transfusions of packed red blood cells and platelets than patients with no bleeding (p = 0.047).

CONCLUSIONS: Although bleeding complications did not differ significantly between the 3 drugs, several risk factors for bleeding events were identified. A considerable rate of bleeding events occurred in this high-risk patient population.

Key Words: acute coronary syndromes, bleeding, glycoprotein IIb/IIIa inhibitors, thrombocytopenia

Published Online, September 21, 2004. www.theannals.com, DOI 10.1345/aph.1E048

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