Acute Thrombocytopenia in Patients Treated with the Oral Glycoprotein IIb/IIIa Inhibitors Xemilofiban and Orbofiban: Evidence for an Immune Etiology

Jacqueline A. Brassard; Brian R. Curtis; Richard A. Cooper; John Ferguson; Wendy Komocsar; Maria Ehardt; Stuart Kupfer; Clement Maurath; Edward Swabb; Christopher P. Cannon; Richard H. Aster

doi:10.1055/s-0037-1613330

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2002; 88(06): 892-897
DOI: 10.1055/s-0037-1613330

In Focus

Schattauer GmbH

Acute Thrombocytopenia in Patients Treated with the Oral Glycoprotein IIb/IIIa Inhibitors Xemilofiban and Orbofiban: Evidence for an Immune Etiology

Authors

Jacqueline A. Brassard

³Pharmacia Corporation, St. Louis MO
Brian R. Curtis

¹The Blood Research Institute, Blood Center of Wisconsin, Milwaukee, WI
Richard A. Cooper

²Medical College of Wisconsin, Milwaukee, WI
John Ferguson

³Pharmacia Corporation, St. Louis MO
Wendy Komocsar

³Pharmacia Corporation, St. Louis MO
Maria Ehardt

¹The Blood Research Institute, Blood Center of Wisconsin, Milwaukee, WI
Stuart Kupfer

³Pharmacia Corporation, St. Louis MO
Clement Maurath

³Pharmacia Corporation, St. Louis MO
Edward Swabb

³Pharmacia Corporation, St. Louis MO
Christopher P. Cannon

⁴The Brigham and Women’s Hospital, Boston Massachusetts, U.S.A.
Richard H. Aster

¹The Blood Research Institute, Blood Center of Wisconsin, Milwaukee, WI

²Medical College of Wisconsin, Milwaukee, WI

Abstract

Summary

Thrombocytopenic episodes occurring in 18,845 patients treated with the GPIIb/IIIa inhibitors xemilofiban and orbofiban (“fibans”) were analyzed by a blinded review panel and 73 patients were classified as having “possible fiban-induced thrombocytopenia”. When the treatment codes were broken, a significant association between drug exposure and assignment to this group was found (p <0.001). Twenty-eight (82%) of 34 archived serum samples from these patients contained fiban-dependent antibodies specific for GPIIb/IIIa, but no such antibodies were found in 61 drug treated patients not classified as having “possible fiban-induced thrombocytopenia” (p <0.001). We conclude that fiban-dependent antibodies were the major cause of acute, severe thrombocytopenia in patients judged on the basis of clinical findings to have thrombocytopenia “possibly-induced” by xemilofiban and orbofiban. Measurement of drug-dependent antibodies may be helpful in determining the basis for acute thrombocytopenia in fiban-treated patients and possibly for identification of patients at risk to develop thrombocytopenia.

Keywords

Platelets - GPIIb/IIIa inhibitors - antibodies

Full Text

References

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