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abciximab (ReoPro)

Fab fragment of chimeric human-murine monoclonal antibody 7E3. Tradename: ReoPro. Indications: 1) adjunctive agent with angioplasty (PTCA) [4] a) may be useful for acute coronary syndrome without persistent ST segment elevation [3] b) benefit may be limited to troponin I-positive patients < 70 years of age [6] 2) atherectomy [8] 3) not for use in association with thrombolysis - does not improve patient outcomes [7] Contraindications: 1) active internal bleeding 2) GI or genitourinary (GU) bleeding within 2 weeks 3) history of CVA within 2 years or prior CVA with residual neurologic deficit 4) international normalized ratio (INR) > 1.2 5) bleeding diathesis 6) thrombocytopenia < 100,000/mm3 7) recent (within 6 weeks) major surgery or trauma 8) intracranial tumor, arteriovenous malformation or aneurysm 9) uncontrolled hypertension (> 170/110) 10) vasculitis 11) concurrent use of dextran 12) known hypersensitivity to abciximab or murine proteins 13) coronary artery bypass graft (CABG) likely (long 1/2 life) Caution: 1) risk of major bleeding due to abciximab is increased a) patients > 75 kg b) elderly patients (> 65 years) c) history of previous GI disease d) recent thrombolytic therapy 2) increased risk during or after PTCA (independent of abciximab) a) unsuccessful PTCA b) PTCA procedure lasting > 70 minutes c) PTCA performed within 12 hours of symptoms of myocardial infarction Dosage: 1) 0.25 mg/kg IV bolus 10-60 minutes prior to angioplasty - bolus dose must be filtered through a 0.22 micron filter 2) then 10 ug/min infusion for 12 hours - must be infused through an in-line 0.22 micron filter Liquid: 2 mg/mL, 5 mL. Pharmacokinetics: - long 1/2 life [7] Monitor: 1) prothrombin time (PT) 2) activated partial thromboplastin time (aPTT) 3) hemoglobin/hematocrit 4) platelet count 5) fibrinogen 6) fibrin split products 7) transfusion requirements 8) signs of hypersensitivity 9) guaiac stools 10) hematuria Adverse effects: 1) antichimeric antibody response occurs in 6% of patients a) no increase in hypersensitivity b) no increase in thrombocytopenia 2) common (> 10%) a) hypotension b) pain c) nausea d) major bleeding episode 3) less common (1-10%) - bradycardia, peripheral edema, minor bleeding, thrombocytopenia, anemia, pleural effusion Mechanism of action: -> antiplatelet agent -> inhibits platelet glycoprotein IIb/IIIa receptor

Interactions

drug adverse effects of antiplatelet agents

Related

glycoprotein IIB/IIIA

General

glycoprotein IIb/IIIa inhibitor pharmaceutical monoclonal antibody

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Kaiser Permanente Northern California Regional Drug Formulary, 1998
  3. Journal Watch 22(6):47, 2002 Boersma E, Harrington RA, Moliterno DJ, White H, Theroux P, Van de Werf F, de Torbal A, Armstrong PW, Wallentin LC, Wilcox RG, Simes J, Califf RM, Topol EJ, Simoons ML. Platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: a meta-analysis of all major randomised clinical trials. Lancet. 2002 Jan 19;359(9302):189-98. Erratum in: Lancet 2002 Jun 15;359(9323):2120. PMID: 11812552
  4. Kandzari DE, Hasselblad V, Tcheng JE, Stone GW, Califf RM, Kastrati A, Neumann FJ, Brener SJ, Montalescot G, Kong DF, Harrington RA. Improved clinical outcomes with abciximab therapy in acute myocardial infarction: a systematic overview of randomized clinical trials. Am Heart J. 2004 Mar;147(3):457-62. Review. PMID: 14999194
  5. Department of Veterans Affairs, VA National Formulary
  6. Ndrepepa G, Kastrati A, Mehilli J, Neumann FJ, ten Berg J, Bruskina O, Dotzer F, Seyfarth M, Pache J, Dirschinger J, Ulm K, Berger PB, Schomig A. Age-dependent effect of abciximab in patients with acute coronary syndromes treated with percutaneous coronary interventions. Circulation. 2006 Nov 7;114(19):2040-6. Epub 2006 Oct 23. PMID: 17060377 - Montalescot G. Glycoprotein IIb/IIIa inhibitors in the elderly: fear of age or age of fear? Circulation. 2006 Nov 7;114(19):2004-6. PMID: 17088473
  7. Medical Knowledge Self Assessment Program (MKSAP) 14, 16, 18 American College of Physicians, Philadelphia 2006, 2013, 2018.
  8. Deprecated Reference