Abciximab dosing

Abciximab in acute ischemic stroke a randomized, double-blind, placebo-controlled, dose-escalation study. The Abciximab in Ischemic Stroke Investigators. Stroke 2000 31 601-609. 

Qureshi Al, Harris-Lane P, Kirmani IF, Janjua N, Divani AA, Mohammad YM, Suarez Jl, Montgomery MO. Intra-arterial reteplase and intravenous abciximab in patients with acute ischemic stroke an open-label, dose-ranging, phase I study. Neurosurgery 2006 59 789-796 [discussion 796-787]. 

The abciximab in Acute Ischemic Stroke trial was a randomized, placebo-controlled dose-escalation study to examine the safety of abciximab in acute stroke. It randomized 74 patients within 24 hours of stroke onset to receive one of four doses of abciximab (by bolus with or without additional infusion, 54 patients) or placebo (20 patients). The median baseline National Institute of Health Stroke Scale (NIHSS) score was 15. The rates of asymptomatic ICH were 19% in the intervention group compared to 5% in the placebo group p = 0.07). Most (9 of 11) of the asymptomatic ICH patients had more severe stroke (NIHSS >14). No cases of symptomatic ICH or major systemic bleeding occurred. There was a trend toward a lower rate of stroke recurrence (2% vs. 5%) and a higher rate of functional recovery at 3 months in the group treated with abciximab than with placebo. 

In 2004, the abciximab and rt-PA in Acute Ischemic Stroke Treatment trial treated hve patients with abciximab and half dose of rt-PA within 3 hours of symptom onset. The primary aim was to examine the frequency of SICH at 24 hours. This occurred in one of the five patients. The median NIHSS improvement was 6. 

Doses and contraindications to glycoprotein Ilb/IIIa receptor blockers are described in Table 5-2. Major bleeding and rates of transfusion are increased with administration of a glycoprotein Ilb/IIIa receptor inhibitor in combination with aspirin and an anticoagulant,30 but there is no increased risk of intracranial hemorrhage in the absence of concomitant fibrinolytic treatment. The risk of thrombocytopenia with tirofiban and eptifibatide appears lower than that with abciximab. Bleeding risks appear similar between agents. 

REOPRO (Abciximab) [mammalian cell culture-expressed Fab fragment of a chimeric human-murine monoclonal Ab] Lilly Liquid 10 mg single dose vial... 

Three intravenous GPIIb/llla inhibitors are currently available for clinical use abciximab, tirofiban, and eptifibatide (4-7). Their mechanisms of action, important differences in pharmacology as well as approved indications and dosing regimens are listed in Table I. 

TNK + UFH versus full-dose TNK + UFH Abciximab + half-dose TNK +... 

The Assessment of the Safety and Efficacy of the New Thrombolytic regimen (ASSENT)-3 Investigators. Trial of abciximab with and without low-dose reteplase for acute myocardial infarction. Strategies for Patency Enhancement in the Emergency Department (SPEED) Group. Circulation 2000 101 2788. 

Efficacy and safety oftenecteplase in combination with enoxaparin, abciximab, or unfractionated heparin the ASSENT-3 randomized trial in acute myocardial infarction. Lancet 2001 358 605. LincoffAM, Califf RM, Van De WerfE etal. Mortality at I year with combination platelet glycoprotein llb/llla inhibition and reduced-dose fibrinolytic therapy vs conventional fibrinolytic therapy for acute myocardial infarction GUSTO V randomized trial. JAMA 2002 288 2130. 

Bolognese L, Falsini G, Liistro R et al. Randomized comparison of upstream tirofiban versus downstream high bolus dose tirofiban or abciximab on tissue-level perfusion and troponin release in high-risk acute coronary syndromes treated with percutaneous coronary interventions the EVEREST trial. J Am Coll Cardiol 2006 47 522-528. 

Mehilli J, Kastrati A, Schuhlen H, et al. Randomized clinical trial of abciximab in diabetic patients undergoing elective percutaneous coronary interventions after treatment with a high loading dose of clopidogrel. Circulation 2004 I 10 3627-3635. 

In the NICE-3 study (14), 661 ACS patients were treated with enoxaparin SC I mg/kg plus abciximab, eptifibatide, or tirofiban at standard doses. Two strategies were combined for the transition from the ward to the catheter laboratory no interruption and no addition of enoxaparin for PCI within eight hours of the last SC injection and an additive IV bolus of 0.3 mg/kg when PCI was performed between 8 and 12 hours of the last SC injection. The major bleeding rate was 4.5% and the in-hospital death/MI/urgent target vessel revascularization rate was 5.7%. 

Gunasekara AB Walters DL, Aroney CN. Comparison of abciximab with high-dose tirofiban in patients undergoing percutaneous coronary intervention. IntJ Cardiol 2005 [Epub ahead of print]. 

Abciximab given as bolus injection plus infusion together with low-dose heparin. c Patients with unstable angina undergoing angioplasty with or without abciximab. d Abciximab and balloon angioplasty. e Abciximab and stent implantation. 

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... 

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