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Ann Thorac Surg 2000;70:516-526
© 2000 The Society of Thoracic Surgeons

Original articles: cardiovascular

Abciximab and bleeding during coronary surgery: results from the EPILOG and EPISTENT trials*

A. Michael Lincoff, MDa, LeRoy A. LeNarz, MDc, George J. Despotis, MDd, Peter K. Smith, MDe, Joan E. Booth, RNa, Russell E. Raymond, DOa, Shelly K. Sapp, MSb, Catherine F. Cabot, MDg, James E. Tcheng, MDf, Robert M. Califf, MDf, Mark B. Effron, MDc, Eric J. Topol, MDa, EPILOG and EPISTENT Investigators

a Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
b Department of Biostatistics, Cleveland Clinic Foundation, Cleveland, Ohio, USA
c Eli Lilly and Company, Indianapolis, Indiana, USA
d Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
e Division of Thoracic Surgery, Duke University Medical Center, Durham, North Carolina, USA
f Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
g Centocor, Malvern, Pennsylvania, USA

Address reprint requests to Dr Lincoff, Department of Cardiology, Desk F25, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195

Background. Abciximab during percutaneous coronary revascularization reduces ischemic complications, but concern exists regarding increased bleeding risk should emergency coronary surgical procedures be required.

Methods. Outcomes were assessed among 85 patients who required coronary artery bypass grafting operations after coronary intervention in two randomized placebo-controlled trials of abciximab. Comparisons were made between patients in the pooled placebo and abciximab groups.

Results. The incidence of coronary surgical procedures was 2.17% and 1.28% among patients randomized to placebo and abciximab, respectively (p = 0.021). Platelet transfusions were administered to 32% and 52% of patients in the placebo and abciximab groups, respectively (p = 0.059). Rates of major blood loss were 79% and 88% in the placebo and abciximab groups, respectively (p = 0.27); transfusions of packed red blood cells or whole blood were administered in 74% and 80% of patients, respectively (p = 0.53). Surgical reexploration for bleeding was required in 3% and 12% of patients, respectively. Death and myocardial infarction tended to occur less frequently among patients who had received abciximab.

Conclusions. Urgent coronary artery bypass grafting operations can be performed without an incremental increase in major hemorrhagic risk among patients on abciximab therapy.




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