Use of platelet glycoprotein IIb/IIIa inhibitors and spontaneous pulmonary hemorrhage

The use of platelet glycoprotein (GP) IIb/IIIa inhibitors in patients undergoing percutaneous coronary intervention has resulted in an impressive reduction in adverse events. Pulmonary hemorrhage is a rare but potentially lethal complication of antithrombotic and antiplatelet therapy. We analyzed the incidence of spontaneous pulmonary hemorrhage following the use of platelet GP IIb/IIIa inhibitors. The medical records of 1,020 consecutive patients who received GP IIb/IIIa inhibitors and underwent PCI at our institution between August 1997 and December 1999 were reviewed. Diffuse pulmonary hemorrhage developed in 7 patients (0.68%), two of whom died. Five of 7 patients with pulmonary hemorrhage had activated clotting times > 250 seconds during the procedure. Activated partial thromboplastin time measured at the time of pulmonary hemorrhage was elevated in all patients (mean, 85 seconds; range, 69 95 seconds). All patients had history of congestive heart failure and had elevated pulmonary capillary wedge pressure and/or left ventricular end-diastolic pressure at the time of the index procedure. Six patients also had evidence of baseline radiographic abnormalities. Diffuse pulmonary hemorrhage is a potentially disastrous complication of GP Ilb/Illa antagonists. No specific predictors can be identified, but evidence of pulmonary congestion, baseline pulmonary abnormalities and use of higher heparin dosages may predispose patients to this serious complication.