Korean Circ J.  2007 Nov;37(11):594-598. 10.4070/kcj.2007.37.11.594.

A Case of Abciximab Induced Acute Profound Thrombocytopenia Resulting in Compartment Syndrome of the Forearm from Massive Bleeding at the Brachial Artery Access Site

• Kim MH
• Jung ES
• Yoon SG
• Doh JH
• Namgung J
• Lee SY
• Kwon SU
• Lee WR
• Um TH

• KMID: 1909622
• DOI: http://doi.org/10.4070/kcj.2007.37.11.594

Abstract

Abciximab is one of the glycoprotein IIb/IIIa receptor inhibitors, and it is known to be effective for preventing and treating the thrombotic complications of percutaneous coronary intervention (PCI). On the other hand, there is an increasing risk of hemorrhagic complications when using abciximab, especially in the case of abciximab-induced thrombocytopenia. Acute profound thrombocytopenia is a rare, but life threatening adverse reaction to abciximab, and it can even occur within a few hours of the first exposure. We report here on a case of 56 year-old woman who experienced massive bleeding of her brachial artery access site. This was caused by abciximab-induced acute profound thrombocytopenia after performing PCI concomitant with using abciximab.

Keyword

Abciximab; Thrombocytopenia; Compartment syndromes; Angioplasty

MeSH Terms

Angioplasty
Brachial Artery*
Compartment Syndromes*
Female
Forearm*
Glycoproteins
Hand
Hemorrhage*
Humans
Middle Aged
Percutaneous Coronary Intervention
Thrombocytopenia*
Glycoproteins

Figure

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  Fig. 1 A baseline electrocardiogram showed no abnormality of the ST segments.

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  Fig. 2 AP cranial view. A CAG of the left coronary artery. A: the baseline CAG revealed about 85% stenosis of the middle LAD. B: after stent implantation, a CAG revealed no residual stenosis of the LAD. AP: anteroposterior, CAG: coronary angiogram, LAD: left anterior descending.

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  Fig. 3 When chest pain developed after PCI, an electrocardiogram showed ST segment elevations in the anterior chest leads. PCI: percutaneous coronary intervention.

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  Fig. 4 AP cranial view. A CAG of the left coronary artery. A: an emergency CAG showed subtotal occlusion (>90%) of the middle LAD, which was previously a stent implantation site. B: after the abciximab infusion, thrombosuction and another stent implantation, the CAG showed no residual stenosis or dissection with restored TIMI 3 flow. AP: anteroposterior, CAG: coronary angiogram, LAD: left anterior descending, TIMI: thrombolysis in myocardial infarction.

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  Fig. 5 These pictures showed a severe hematoma and bullae of the arm.

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  Fig. 6 Microscopic findings of the peripheral blood smears showed no aggregation of platelets and a very low platelet count.

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  Fig. 7 Change of platelet counts in patients treated with abciximab. PCI: percutaneous coronary intervention.

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