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abciximab

Abciximab

Abciximab is made from the Fab fragments of an immunoglobulin that targets the glycoprotein IIbIIIa receptor on the platelet membrane.

Abciximab (previously known as c7E3 Fab), a glycoprotein IIb/IIIa receptor antagonist manufactured by Janssen Biologics BV and distributed by Eli Lilly under the trade name ReoPro, is a platelet aggregation inhibitor mainly used during and after coronary artery procedures like angioplasty to prevent platelets from sticking together and causing thrombus (blood clot) formation within the coronary artery. It is a glycoprotein IIb/IIIa inhibitor.

While abciximab has a short plasma half-life, due to its strong affinity for its receptor on the platelets, it may occupy some receptors for weeks. In practice, platelet aggregation gradually returns to normal about 96 to 120 hours after discontinuation of the drug 1).

Rx: 0.25 mg/kg IV bolus over at least 1 min, 10-60 min before start of PCI, THEN

0.125 mcg/kg/min IV continuous infusion for 12 hr; not to exceed infusion rate of 10 mcg/min


Patel et al. evaluated the efficacy of treatment of acute thrombus formation with abciximab, as well as the results of pre-procedure platelet inhibition testing.

Acute thrombus formation was encountered in five patients following PED placement (5%). Early angiographic signs were present in all cases and included progressive stagnation of blood flow in covered side branches, occlusion of covered side branches, excessive stagnation of blood flow in the target aneurysm, as well as occlusion of the target aneurysm. These sequelae completely resolved following abciximab treatment in all five cases, with no permanent neurological morbidity or mortality. Four of the five patients had a pre-procedure P2Y12 value >200 (range 201-227).

Progressive stagnation or occlusion of covered side branches or target aneurysm are early angiographic signs of acute thrombus formation following PED placement and should prompt immediate treatment with a glycoprotein IIb/IIIa inhibitor. Platelet inhibition testing may help identify those patients who are at an increased risk for this complication 2).


A review provides a comprehensive evaluation of the current published literature pertaining to the use of all available GP IIb/IIIa inhibitors for thromboembolic complications, providing recommendations for dosing and administration of abciximab, eptifibatide, and tirofiban based on previously published rates of efficacy and intracranial hemorrhage 3).


Abciximab produces a high rate of angiographic improvement and a low incidence of postprocedural infarct in neuroendovascular procedures complicated by thromboemboli. IA abciximab produces greater angiographic improvement than IV treatment. Postprocedural infarction is less common in patients with complete angiographic response than in those with partial or no response 4).


In acute ICA-MCA/distal ICA occlusions, extracranial stenting followed by intracranial IA Abciximab and thrombectomy appears feasible, effective, and safe. Further evaluation of this treatment strategy is warranted 5).


There was no statistically significant difference in the rate of ischemic stroke or postprocedural hemorrhage with the use of abciximab compared with the use of eptifibatide in treatment of intraprocedural thrombosis 6).

1)
Tanguay, J.F., Eur Heart J 1999; 1 (suppl E): E27-E35
2)
Patel A, Miller TR, Shivashankar R, Jindal G, Gandhi D. Early angiographic signs of acute thrombus formation following cerebral aneurysm treatment with the Pipeline embolization device. J Neurointerv Surg. 2017 Nov;9(11):1125-1130. doi: 10.1136/neurintsurg-2016-012701. Epub 2016 Oct 21. PubMed PMID: 27770038.
3)
Dornbos D 3rd, Katz JS, Youssef P, Powers CJ, Nimjee SM. Glycoprotein IIb/IIIa Inhibitors in Prevention and Rescue Treatment of Thromboembolic Complications During Endovascular Embolization of Intracranial Aneurysms. Neurosurgery. 2017 May 3. doi: 10.1093/neuros/nyx170. [Epub ahead of print] PubMed PMID: 28472526.
4)
Kansagra AP, McEachern JD, Madaelil TP, Wallace AN, Cross DT 3rd, Moran CJ, Derdeyn CP. Intra-arterial versus intravenous abciximab therapy for thromboembolic complications of neuroendovascular procedures: case review and meta-analysis. J Neurointerv Surg. 2017 Feb;9(2):131-136. doi: 10.1136/neurintsurg-2016-012587. Epub 2016 Aug 18. PubMed PMID: 27540089.
5)
Al-Mufti F, Amuluru K, Manning NW, Khan I, Peeling L, Gandhi CD, Prestigiacomo CJ, Pushchinska G, Fiorella D, Woo HH. Emergent carotid stenting and intra-arterial abciximab in acute ischemic stroke due to tandem occlusion. Br J Neurosurg. 2017 Oct;31(5):573-579. doi: 10.1080/02688697.2017.1297377. Epub 2017 Mar 15. PubMed PMID: 28298139.
6)
Adeeb N, Griessenauer CJ, Moore JM, Foreman PM, Shallwani H, Motiei-Langroudi R, Gupta R, Baccin CE, Alturki A, Harrigan MR, Siddiqui AH, Levy EI, Ogilvy CS, Thomas AJ. Ischemic Stroke After Treatment of Intraprocedural Thrombosis During Stent-Assisted Coiling and Flow Diversion. Stroke. 2017 Apr;48(4):1098-1100. doi: 10.1161/STROKEAHA.116.016521. Epub 2017 Feb 28. PubMed PMID: 28246277.
abciximab.txt · Last modified: 2017/12/26 17:25 by administrador