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  • Title: Glycoprotein IIb/IIIa receptor inhibition with abciximab during percutaneous coronary interventions increases the risk of bleeding in patients with impaired renal function.
    Author: Pinkau T, Ndrepepa G, Kastrati A, Mann JF, Schulz S, Mehilli J, Schömig A.
    Journal: Cardiology; 2008; 111(4):247-53. PubMed ID: 18434733.
    Abstract:
    OBJECTIVE: Whether patients with renal insufficiency (RI) undergoing percutaneous coronary interventions (PCI) benefit from abciximab added to clopidogrel plus aspirin is unknown. METHODS: The study included 2,159 patients with coronary artery disease undergoing elective PCI. RI was assessed using glomerular filtration rate (GFR) cutoff values: moderate-to-severe RI (GFR <or=60 ml/min), mild RI (GFR >60 to <or=90 ml/min) and no RI (GFR >90 ml/min). The 30-day incidence of major adverse cardiac events (MACE) and bleeding were the primary outcome analyses. RESULTS: In patients with moderate-to-severe RI, mild RI and no RI, MACE occurred in 5.2, 5 and 2.9%, respectively, in the abciximab group (p = 0.14) and in 4.2, 3.8 and 4.0%, respectively, in the placebo group (p = 0.96). In the abciximab group, bleeding complications occurred in 8.9% of patients with moderate-to-severe RI, in 2.0% with mild RI and in 2.1% with no RI (p < 0.001). Multivariable analysis identified GFR as an independent correlate of MACE (p = 0.03) and bleeding (p = 0.001) with a trend for an interaction between GFR and abciximab regarding major bleeding (p = 0.22). CONCLUSIONS: In patients with RI undergoing PCI, adding abciximab to clopidogrel plus aspirin increases the risk of bleeding without benefit in reducing the risk of ischemic complications within the first 30 days.
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