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Reduction in vascular access site bleeding in sequential abciximab coronary intervention trials

James C Blankenship1, Craig Balog, Shelly K Sapp

  • 1Department of Cardiology, Geisinger Medical Center, Danville, Pennsylvania 17822, USA. jblankenship@geisinger.edu

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|November 28, 2002
PubMed

Insights

Vascular access site bleeding complications significantly decreased across three trials, particularly with abciximab. Improved management strategies and dosing have largely eliminated excess bleeding risks during coronary interventions.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Clinical Trials

Background:

  • Vascular access site bleeding is a significant complication in percutaneous coronary interventions.
  • Abciximab, an antiplatelet agent, has been associated with increased bleeding risk.

Purpose of the Study:

  • To quantify the reduction in vascular access site bleeding complications across the EPIC, EPILOG, and EPISTENT trials.
  • To assess the impact of abciximab on bleeding complications over time and with evolving management strategies.

Main Methods:

  • Analysis of pooled data from three large-scale clinical trials: EPIC, EPILOG, and EPISTENT.
  • Comparison of vascular access site bleeding rates (major and minor) between patients receiving abciximab and those receiving placebo (or heparin alone).
  • Statistical analysis to determine the significance of observed bleeding rate changes and the effect of abciximab.

Main Results:

  • A progressive and significant decrease in combined major and minor vascular access site bleeding was observed in both non-abciximab and abciximab groups across the trials (P < 0.001).
  • While abciximab was associated with more major bleeds in the EPIC trial (OR 3.2), this difference was not significant in EPILOG or EPISTENT.
  • The incidence of bleeding complications in abciximab patients decreased substantially from EPIC (20%) to EPILOG (5.8%) and EPISTENT (2.2%).

Conclusions:

  • Modified dosing strategies for abciximab and heparin, coupled with enhanced vascular access site management, have significantly reduced bleeding risks.
  • The excess vascular access site bleeding historically associated with abciximab has been effectively mitigated through these advancements.
  • These findings support the continued use of abciximab in conjunction with optimized protocols for coronary interventions.

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