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Intracranial Hemorrhage Following Neuroendovascular Procedures with Abciximab is Associated with High Mortality: A Multicenter Series

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Abstract

Background

Abciximab is being used as an adjunct to neuroendovascular procedures both to prevent and treat ischemic sequelae. Experience with abciximab in this setting is limited; major bleeding complications, including fatal intracranial hemorrhage (ICH), are of particular concern. We report our multicenter experience with ICH following the administration of abciximab during neuroendovascular procedures.

Methods

We identified neuroendovascular procedures (including cerebral angiograms, aneurysm coiling procedures, angioplasty/vascular stenting procedures, and emergent revascularization procedures) that used abciximab at Mayo Clinic Hospitals in Rochester, Jacksonville, and Phoenix between November 2000 and April 2009. Cases of periprocedural ICH were identified and pertinent demographic, historical, procedural, radiographic, and laboratory data were collected. Clinical outcome was measured either at death or discharge by the Glasgow Outcome Scale (GOS).

Results

Abciximab was used in 51 neuroendovascular procedures; 9 cases of ICH were identified. Procedures performed and indications for abciximab use varied. Route of abciximab administration included IV bolus only (n = 4), IA bolus followed by IV infusion (n = 3), IV bolus followed by IV infusion (n = 1), and IV infusion without preceding bolus (n = 1). All but 1 of the patients received concomitant periprocedural antiplatelet, anticoagulant, or thrombolytic agents. Eight of the 9 cases of ICH were detected within 7 h of abciximab administration. ICH pattern varied. Four patients died following ICH.

Conclusions

Adjunctive use of abciximab to prevent or treat ischemic sequelae during neuroendovascular procedures is associated with a high risk of ICH (18%). We report 9 cases of ICH associated with abciximab administration during neuroendovascular procedures with 44% mortality.

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Abbreviations

ACT:

Activated clotting time

EVD:

External ventricular drain

GOS:

Glasgow outcome scale

GP IIb/IIIa:

Glycoprotein IIb/IIIa

GPI:

Glycoprotein IIb/IIIa receptor inhibitor

IA:

Intra-arterial

ICH:

Intracranial hemorrhage

IPH:

Intraparenchymal hemorrhage

IV:

Intravenous

IVH:

Intraventricular hemorrhage

kg:

Kilograms

mg:

Milligrams

mcg:

Micrograms

min:

Minutes

ml:

Milliliters

PCI:

Percutaneous coronary intervention

PTT:

Partial thromboplastin time

r-tPA:

Recombinant tissue plasminogen activator

SAH:

Subarachnoid hemorrhage

SDH:

Subdural hemorrhage

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Acknowledgments

A portion of the preliminary data was presented in poster form at the Society of Vascular and Interventional Neurology annual meeting in Miami, FL, October 2008; as an oral presentation at the Florida Society of Neurology annual meeting in Orlando, FL, September 2009; and in poster form at the Neurocritical Care Society annual meeting in New Orleans, LA, November 2009. The authors wish to thank Ms. Katherine Purcell for her editorial assistance in preparing this manuscript.

Conflicts of interest statement

The authors report no conflicts of interest or pertinent financial disclosures.

Author information

Authors and Affiliations

  1. Department of Neurology, Mayo Clinic Jacksonville, Jacksonville, FL, USA

    Ryan D. Walsh & Kevin M. Barrett

  2. Department of Neurology, Mayo Clinic Arizona, Scottsdale, AZ, USA

    Maria I. Aguilar

  3. Department of Neurosurgery, Mayo Clinic Rochester, Rochester, MN, USA

    Giuseppe Lanzino

  4. Department of Neurosurgery, Mayo Clinic Jacksonville, Jacksonville, FL, USA

    Ricardo A. Hanel

  5. Department of Neuroradiology, Mayo Clinic Jacksonville, Jacksonville, FL, USA

    David A. Miller

  6. Department of Radiology, Mayo Clinic Arizona, Scottsdale, AZ, USA

    Brian W. Chong

  7. Departments of Neurology and Critical Care, Mayo Clinic College of Medicine, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA

    W. David Freeman

Authors
  1. Ryan D. Walsh
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  2. Kevin M. Barrett
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  3. Maria I. Aguilar
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Corresponding author

Correspondence to W. David Freeman.

Additional information

Commercial products: Reopro® (Abciximab) by Eli Lilly, Indianapolis, IN.

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Walsh, R.D., Barrett, K.M., Aguilar, M.I. et al. Intracranial Hemorrhage Following Neuroendovascular Procedures with Abciximab is Associated with High Mortality: A Multicenter Series. Neurocrit Care 15, 85–95 (2011). https://doi.org/10.1007/s12028-010-9338-1

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  • DOI: https://doi.org/10.1007/s12028-010-9338-1

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