Abciximab Alteplase

A) Abciximab Alteplase Factor VIII Streptokinase Vitamin K... 

FFeart disease, particularly clogged blood vessels, is also treated with recombinant products. Alteplase (Activase ), a human recombinant protein that breaks down fibrin, is used immediately after a stroke or heart attack to break down platelet-trapping clots in small blood vessels of the heart or brain and thus improve the patient s chances for recovery. Purified enzymes from bacteria are used for the same purposes. Abciximab (ReoPro ), a monoclonal antibody to... 

Abciximab in Ischemic Stroke Investigators (2000) Abciximab in acute ischemic stroke a randomized, double-blind, placebo-controlled, dose-escalation study. Stroke 31 601-609 Albers GW, Clark WM (1999) For the ATLANTIS Study Investigators. The ATLANTIS rt-PA (Alteplase) acute stroke trial final results. Cerebrovasc Dis 9 126 Alexandrov AV, Burgin WS, Demchuk AM, El-Mitwalli A, Grotta JC (2001) Speed of intracranial clot lysis with intravenous tissue plasminogen activator therapy sonographic classification and short-term improvement. Circulation 103 2897-2902... 

Controlled clinical trials have shown that alteplase improves the clinical outcome in patients with ischemic stroke if given within 3 hours after the onset of symptoms. Similar trials of streptokinase resulted in unacceptably high rates of bleeding. Glycoprotein Ilb/EIa receptor inhibitors like abciximab have not been tested in ischemic stroke. Vitamin K and factor Vni may actually worsen the patient s outcome. The answer is (B). 

The manufacturers of lepirudin say that no formal interaction studies have been done but they reasonably warn that the concurrent use of lepirudin and other thrombolytics (they name alteplase and streptokinase) may increase the risk of Isleeding complications and considerably enhance the effect of lepirudin on the aPTT. They also warn about the increased risks of bleeding if antiplatelet drugs such as ciopidogrei, ticlopidine, abciximab, eptifibatide or tirofiban are used concurrently... 

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