Fatal Hemorrhagic Transformation of Acute Cerebral Infarction After the Use of Abciximab

To the Editor: The Abciximab in Ischemic Stroke Investigators reported the encouraging results of their randomized, double-blind, placebo-controlled, dose-escalation trial.1 Of 74 eligible and consenting patients presenting within 24 hours of onset of their ischemic stroke, 54 patients were treated with 4 escalating doses of intravenous abciximab and 20 patients with placebo. The scheduled post-study CT brain scan detected asymptomatic parenchymal hemorrhages in 7% of abciximab-treated patients and 5% of placebo-treated patients; another 11% of abciximab-treated patients had asymptomatic parenchymal hemorrhages on unscheduled brain imaging (CT or MRI) performed on days 2 through 35. Symptomatic hemorrhagic transformation was not seen, while asymptomatic parenchymal hemorrhages were associated with a higher baseline National Institute of Health Stroke Scale (NIHSS) score. We would raise the following issue for clarification by the authors and report our limited experience of using abciximab in Chinese stroke patients. Concomitant use of antithrombotic medications during the time period of diagnosing parenchymal hemorrhage was listed in Table 3 of the article.1 The scheduled CT brain scan detected asymptomatic parenchymal hemorrhages in patients A, D, G, H, and I, who also received concomitant antithrombotic medications, such as systemic heparin, low-dose heparin, aspirin, and warfarin sodium. Nevertheless, the study protocol required that antiplatelet agents or anticoagulants not be administered until the results of the scheduled CT brain scan became available (as …