Abciximab Heparin

The data for the use of GP Ilb/Illa inhibitors in conjunction with lAT are even more scant, and are limited to case reports. Intravenous abciximab has been successfully used as adjunctive therapy to lA rt-PA or UK in cases of acute stroke. Desh-mukh et al. reported on 21 patients with large vessel occlusion refractory to lAT with rt-PA who were treated with IV and/or lA abciximab, eptifibatide, or tirofiban. Twelve patients also received IV rt-PA and 18 patients underwent balloon angioplasty. Complete or partial recanalization was achieved in 17 of 21 patients. Three patients (14%) had asymptomatic ICH, but there were no cases of symptomatic ICH. Mangiafico et al. described 21 stroke patients treated with an intravenous bolus of tirofiban and heparin followed by lA urokinase. Nineteen of these patients also underwent balloon angioplasty. TIMI 2-3 flow was achieved in 17 of 21 patients. ICH occurred in 5 of 21 patients (3 symptomatic ICH and 2 SAH), and was fatal in 3... 

Abciximab, aminophylline, amiodarone, amrinone, aspirin, carbamazepine, chlorpromazine, danazol, diltiazem, eptifi-batide, heparin, histamine2-receptor antagonists, low molecular weight heparins, methyldopa, milrinone, procainamide, quinidine, quinine, NSAIDs, thiazide diuretics, ticlopidine, tirofiban, and valproic acid... 

Abciximab is the Fab-fragment of a monoclonal antibody against the receptor. It is used in combination with heparin or aspirin during percutaneous coronary interventions. 

Stop abciximab and heparin infusion if serious bleeding uncontrolled by pressure occurs... 

GUSTO-V (55) Abciximab + reteplase + heparin versus reteplase + heparin 16,588 Death 30 day... 

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. 

Patients with diabetes remain an important subgroup given the evidence supporting reduced revascularization and mortality associated with abciximab in these patients undergoing PCI (38). Compared with a strategy of heparin and GP llb/llla inhibition, diabetic patients treated with bivalirudin experienced a numerically lower but nonsignificant late mortality at 12 months (2,3% vs, 3,9%, P = NS), No differences were observed with short-term bleeding and ischemic outcomes. 

E3 monoclonal antibody to GPIIb/llla (abciximab) is very useful as an antiplatelet drug in high-risk ACSs and PCI, It can be used in conjunction with reduced levels of heparin and with aspirin (Table I), Patients may uncommonly experience sudden severe thrombocytopenia within the early hours of treatment as a side effect. 

Tepes et al. reported the first clinical experience with abcix-imab and urokinase combination therapy in the peripheral circulation (44). Schweizer et al. used abciximab and rt-PA versus rt-PA with ASA in an 84 patient trial and found a significantly shorter duration of thrombolytic infusion was required to achieve lytic success in the combination group as well as improved clinical endpoints of less re-hospitalization, re-intervention, and amputation compared to ASA and heparin (45),... 

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. 

Adverse effects. Haemorrhage occurs but is less of a problem with low doses of heparin it remains a particular risk in patients treated after failed fibrinol5 c therapy for acute myocardial infarction. Platelet transfusion after cessation of abciximab is necessary for refractory or life threatening bleeding. After transfusion, the antibody redistributes to the transfused platelets, reduces the mean level of receptor blockade and improves platelet function. Thrombocytopenia may occur from 1 hour to days after commencing treatment in up to 1% of patients. This necessitates platelet counts at 2-4 hours and then daily if severe, therapy must be stopped and, if necessary, platelets transfused. EDTA-induced pseudothrombocytopenia has been reported and a low platelet count should prompt examination of a blood film for agglutination before therapy is stopped. 

In 7800 patients with chest pain and either ST segment depression or a positive troponin test, the addition of abciximab to unfractionated heparin or low molecular weight heparin in the treatment of acute coronary syndrome was not associated with any significant... 

During postmarketing surveillance of the first 4000 patients treated with abciximab in France, 25 cases of thrombocytopenia (0.6%) were reported, with five severe cases (0.15%) and three acute profound forms (0.08%). In all cases reported, the role of heparin must be taken into account. The thrombocytopenia associated with abciximab differs with that associated with heparin by its rapid onset (within 24 hours), its reversal after platelet transfusion, and its possible association with hemorrhage but not with thrombosis. 

A 65-year-old woman with type 2 diabetes mellitus and coronary artery disease received a 0.25 mg/kg bolus of abciximab at the time of intervention followed by an infusion of 10 micrograms/minute for 12 hours. Her baseline platelet counts were 286 x 10 /1 before use, 385 X 10 /1 at 2 hours, and 296 x 10 /1 at 18 hours. On day 7 she developed petechiae over her legs and her platelet count was 1 x 10 /1. Coagulation tests were normal and there was no evidence of heparin-induced thrombocytopenia. She received 10 units of single-donor platelets and recovered slowly over the next 4 days. The platelet count was 114 x 10 /1 on day 12. 

Kereiakes DJ, Broderick TM, Whang DD, Anderson L, Eye D. Partial reversal of heparin anticoagulation by intravenous protamine in abciximab-treated patients undergoing percutaneous intervention. Am J Cardiol 1997 80(5) 633-4. 

LM is a 50-year-old man who underwent PCI to revascularize a 100% occluded left anterior descending coronary artery. For the procedure he will receive heparin, abciximab, and aspirin. Baseline platelet count is 150,000/mm. Two hours after the bolus dose of abciximab is given, platelet count is TOOO/mm. What clinical intervention(s) should occur ... 

B. Continue abciximab, aspirin, and heparin but give a platelet transfusion. 

E Discontinue abciximab, aspirin, and heparin and give a platelet transfusion. Because abciximab is associated with thrombocytopenia, platelet counts should be monitored carefully. The manufacturer recommends that a platelet count be obtained prior to initiation of abciximab, 2 to 4 hours following the bolus dose, and 24 hours after discontinuing abciximab or prior to patient discharge. If thrombocytopenia is verified, then the following should be employed (see Table A-14). 

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