Increased risk for vascular complications due to GP IIb/IIIa-antagonists in patients with cardiogenic shock supported by intraaortic balloon pump (IABP)

Background

IABP is routinely used to support coronary blood flow and systemic circulation in patients with cardiogenic shock. Our aim was to explore the incidence of vascular complications associated with the use of IABP in this scenario and their influence on mortality.

Methods

Therefor we analysed 204 consecutive patients between 2002 and 2013 treated with IAPB in cardiogenic shock for vascular complications and mortality within 30 days after implantation of IAPB. Primary endpoints were severe bleeding (TIMI-definition: intracranial bleeding, loss of haemoglobin (Hb) > 5 g/dl or haematocrit (PCV) > 15%), vascular complications with therapeutic consequence (venous thrombosis, arterial embolism) and stroke.

Results

80 (39%) patients died within 30 days after implantation of IABP. In 42 (21%) patients, vascular complications occurred: severe bleeding was present in 26 patients (62% of all complications), 13 (31%) patients suffered from venous thrombosis or arterial embolism and 3 (7%) patients from stroke. 25% of the patients who died had a vascular complication. The rate in patients who overcame cardiogenic shock was 17.7% (p = 0.22). Multivariate analyses showed treatment with Glycoprotein (GP) IIb/IIIa- inhibitors to be an independent risk factor for the occurrence of vascular complications (p = 0.04).

Conclusion

Vascular events with the use of IABP are common but in our study, not significantly associated with a higher mortality. Treatment with GP IIb/IIIa-antagonists is associated with a higher risk of vascular events.