Clinical correlates and course of thrombocytopenia during percutaneous coronary intervention in the era of abciximab platelet glycoprotein IIb/IIIa blockade.

BACKGROUND: Thrombocytopenia is infrequently associated with abciximab therapy but may contribute to hemorrhagic risk. Factors associated with development of thrombocytopenia, the role of weight-adjustment in concomitant heparin administration, and clinical outcomes in patients with thrombocytopenia are not well defined. METHODS AND RESULTS: Pooled data from 3 placebo-controlled, randomized trials (EPIC, EPILOG, and EPISTENT) of abciximab therapy during percutaneous coronary intervention identified 178 patients (2. 4% of 7290 patients) in whom thrombocytopenia (platelet count <100 x 10(9)/L) developed after enrollment. Multivariate regression analysis identified age (>65 years; P <.001), weight (<90 kg; P =. 023), baseline platelet count (<200 x 10(9)/L; P <.001), abciximab therapy (P =.002), and enrollment into the EPIC trial (P <.001) to be associated with development of thrombocytopenia. Major and minor nonsurgical hemorrhage and transfusion were more frequent (all P <. 001) in thrombocytopenic patients. Although the primary composite clinical end point of these trials (death, myocardial infarction, or urgent revascularization to 30 days) was observed with similar frequency in patients with (11.2%) and those without (7.9%; P =.114) thrombocytopenia, 30-day mortality rate was higher in thrombocytopenic patients (8.4% vs 0.6%, respectively; P <.001). This excess mortality rate persisted after excluding patients in whom thrombocytopenia was first noted after the performance of coronary bypass surgery (4.8% vs 0.6%; P <.001). Among patients in whom thrombocytopenia developed during these trials, those who received prophylactic abciximab had fewer primary end point events (7.1% vs 23.1%; P =.056) and had a lower 30-day mortality rate (3.5% vs 15.4%; P =.048) than patients with thrombocytopenia who had received prophylactic placebo. CONCLUSIONS: Thrombocytopenia associated with abciximab therapy for percutaneous coronary intervention was more frequent in older, lighter-weight patients, those with lower baseline platelet counts, and in those patients who were enrolled into the EPIC trial. Both bleeding and transfusion events occur more frequently in patients with thrombocytopenia. Patients in whom thrombocytopenia developed during these trials had increased mortality rates to 30 days not attributable to the performance of coronary bypass surgery. Among patients with thrombocytopenia, those who received prophylactic abciximab had better clinical outcomes including survival than those who did not.

Is an increase in CA 125 in breast cancer patients an indicator of pleural metastases?

The retrospective analysis of 250 breast cancer patients with disseminated disease provided evidence that the increase in CA 125 serum levels in these patients was caused by lung metastases or pleural effusions. Seven patients with lung metastases and pleural involvement had elevated CA 125 levels, while in four patients with lung metastases but without pleural effusions CA 125 levels remained normal. In patients with only bone or liver metastases CA 125 levels were usually not elevated. If these results are confirmed, CA 125 would be the first tumour marker in breast cancer whose levels could be associated with one single site of metastases.

CA 72-4 radioimmunoassay for the detection of the TAG-72 carcinoma-associated antigen in serum of patients.

Monoclonal antibody (MAb)B72.3 has been used to detect the presence of TAG-72 in the serum of carcinoma patients. We have developed new anti-TAG-72 MAbs and have selected one of these, CC49, as the "catcher" MAb with 125I-B72.3 as the detecting antibody in a double-determinant immunoradiometric assay. This combination enabled the development of a sequential assay (designated CA 72-4) that showed optimal quantitative properties as demonstrated by such parameters as linear dose-response, high re-producibility, and lack of serum-matrix and "hook-back" effects. Only 3.5% of 744 normal sera and 6.7% of 134 sera from patients with benign gastrointestinal diseases had TAG-72 levels greater than 6 U/ml. Approximately 40% of 303 patients with gastrointestinal malignancies had serum TAG-72 levels of greater than 6 U/ml (55% of the patients with advanced disease). Thirty-six percent of patients with adenocarcinomas of the lung and 24% of patients with ovarian cancer (53% stage IV patients) also had elevated serum TAG-72 levels. A poor correlation was found between the carcinoembryonic antigen (CEA) and TAG-72 values of sera obtained from gastric cancer patients. Thirty-four percent of CEA negative cases were scored positive in the CA 72-4 assay, suggesting the complementarity of the CA 72-4 assay to CEA assays in the analysis of sera from patients with certain malignancies.