Reteplase Abciximab

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

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 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. 

With combination therapy using reteplase and abciximab, a prospective double center study of 50 patients was reported by Drescher et al (50). Recently, however, the 74 patient... 

RELAX trial comparing reteplase and abciximab combination therapy to reteplase monotherapy found no significant difference in safety and efficacy in all major clinical end points (death, amputation, PTA/stent, surgical revascularization), The trial did demonstrate a decreased rate of distal embolic event in the combination group (5 I),... 

Drescher P McGuckin J, Rilling WS, Crain MR. Catheter-directed thrombolytic therapy in peripheral artery occlusions combining reteplase and abciximab, AJR Am J Roentgenol 2003 180(5) 1385-1391. 

Ouriel K, Castaneda p McNamara T, et al, Reteplase monotherapy and reteplase/abciximab combination therapy in peripheral arterial occlusive disease results from the RELAX trial. J Vase Inter/ Radiol 2004 15(3) 229-238. 

The data for the use of GP Ilb/IIIa inhibitors in conjunction with lAT are even more scant and are limited to case reports [18-23]. Deshmukh et al reported on 21 patients with large vessel occlusion refractory to lAT with rt-PA who were treated with IV and/or lA abcix-imab, eptifibatide, or tirofiban [20]. Twelve patients received IV rt-PA and 18 underwent balloon angioplasty. Complete or partial recanalization was achieved in 17/21 patients. Three patients (14%) had asymptomatic ICH, but there were no cases of sICH. Mangiafico et al described 21 stroke patients treated with IV tirofiban and heparin followed by lA urokinase. Nineteen of these patients also underwent balloon angioplasty. TIMI 2-3 flow was achieved in 17/21 patients. ICH occurred in 5/21 patients (3 sICH and 2 SAH) and was fatal in three patients [23]. Qureshi et al described the use of IA reteplase and intravenous abciximab on 20 stroke patients [22]. There was one sICH. Partial or complete recanalization occurred in 13/20 patients. Conversely, the use of abciximab was predictive of asymptomatic SAH (OR 19.2) in nine patients who received this drug as a study protocol violation in the Multi-MERCI Part 1 trial [24]. 

Herrmann HC, Molitemo DJ, Ohman EM, Stebbins AL, Bode C, Betriu A, Forycki F, Miklin JS, Bachinsky WB, Lincoff AM, CaUff RM, Topol EJ. Facilitation of early percutaneous coronary intervention after reteplase with or without abciximab in acute myocardial infarction results from the SPEED (GUSTO-4 Pilot) Trial. J Am Coll Cardiol 2000 36 1489-1496. 

GUSTO V tested half-dose reteplase (5U and 5U) and fiill-dose abciximab compared with fiill-dose reteplase (lOU and lOU) in 16,588 patients in the first 6 hours of STEMI (34). Mortality at 30 days and 1 year was similar in the fiill-dose reteplase and combination reperfiision... 

Similarly, in the Strategies for Patency Enhancement in the Emergency Department (SPEED) trial, patients with STEMI were randomized to receive full-dose reteplase, abciximab, or combination therapy with reduced-dose reteplase + abciximab followed by immediate diagnostic catheterization. The primary endpoint, the rate of TIMI grade 3 flow at 60-90 minutes, was improved with the combination reteplase (5 U -H 5 U) -I- abciximab + standard dose UFH when compared with standard dose reteplase (IOU-hIOU)-h standard dose UFH (61.1% vs. 46.9% p = 0.05) (14). Although the subsequent performance of PCI was neither randomized nor mandated, patients who were treated with combination therapy had improved pre-PCI infarct artery flow, improved procedural success, and trends toward decreases in death, reinfarction, and urgent revascularization compared with those patients who received hill-dose reteplase or abciximab alone before primary PCI. 

Upstream GP Hb/IIIa blockade + primary PCI. Two hundred fifty-three patients with acute STEMI were randomized to therapy with abciximab + PCI or abciximab + reduced-dose reteplase + PCI. While pre-PCI TIMI grade 3 flow was higher among patients treated with combination therapy (TIMI III flow 40% vs. 18% p < 0.01), scintigraphic infarct size was not reduced in the combination therapy arm versus the abciximab alone (13% vs. 11.5%, respectively p = 0.81) (15). There were nonsignificant increases in death/MI (2.4% vs. 1.6%), death/MI/stroke (3.2% vs. 1.6%), and major bleeding (5.6% vs. 1.6%) with combination therapy. Subset analyses of patients who required transfer for primary PCI and those who had earUer times to revascularization revealed no differences. 

Early PCI after reduced-dose reteplase (5 U +5 U) + abciximab bolus doses administered in the emergency department... 

Kastrati A, Mehilli J, Schlotterbeck K, Dotzer F, Dirschinger J, Schmitt C, Nekolla SG, Seyfarth M, Martinoff S, Markwardt C, Clermont G, Gerbig HW, Leiss J, Schwaiger M, Schomig A Bavarian Reperfusion Alternatives Evaluation (BRAVE) Study Investigators. Early administration of reteplase plus abdximab vs. abciximab alone in patients with acute myocardial infarction referred for percutaneous coronary intervention a randomized controlled trial. JAMA 2004 291(8) 947-954. 

Kastrati A, MehUli J, Schlotterbeck K, et al. Early administration of reteplase plus abdximab vs. abciximab alone in patients with acute myocardial infarction referred for percutaneous coronary intervention a randomized controlled trial. JAMA. 2004 291 947-954. 

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