Abciximab Thrombolytics

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. 

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),... 

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. 

The Assessment of the Safety and Efficacy of a New Thrombolytic Regimen (ASSENT) 3 Investigators. Efficacy and safety of tenecteplase in combination with enoxaparin, abciximab, or unfractionated heparin The ASSENT-3 randomised trial in acute myocardial infarction. Lancet 2001 358 605-613. 

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... 

Low-dose aspirin did not alter the pharmacokinetics or pharmacodynamic effects of ai atroban. Neither abciximab nor eptifibatide appeared to alter ai atroban pharmacokinetics. There is no pharmacodynamic interaction between bivalirudin and aspirin, ticlopidine, ciopidogrei, abciximab, eptifibatide or tirofiban. Nevertheless, the manufacturers warn of the increased bleeding risks if argatroban, bivalirudin or lepirudin are used with antiplatelet drugs or thrombolytics. 

The manufacturer of abciximab recommends caution when it is used with other drugs that affect haemostasis, such as heparin, warfarin, thrombolytics and antiplatelet drugs other than aspirin, such as dipyridamole and ticlopidine4 ... 

---