What are the contraindications for using Abciximab (Abixipan) in patients with Non-ST-Elevation Myocardial Infarction (NSTEMI) undergoing catheterization, specifically for Dual Antiplatelet Therapy (DAPT)?

Contraindications for Abciximab in NSTEMI Patients Undergoing Catheterization

Abciximab (Abixipan) is contraindicated in patients with active bleeding, history of stroke within 30 days, significant recent trauma or surgery, intracranial neoplasm, arteriovenous malformation or aneurysm, severe uncontrolled hypertension, thrombocytopenia, and coagulopathy. 1

Absolute Contraindications

• Active internal bleeding or bleeding diathesis 1
• History of stroke within 30 days or any history of hemorrhagic stroke 1
• Intracranial neoplasm, arteriovenous malformation, or aneurysm 2, 3
• Recent major surgery or trauma (within 6 weeks) 2, 3
• Severe uncontrolled hypertension 2, 3
• Thrombocytopenia (platelet count <100,000/mm³) 3, 4
• Current or planned use of oral anticoagulants with INR >1.2 1, 3
• Known hypersensitivity to abciximab or any component of the product 2, 3

Relative Contraindications

• History of prior stroke beyond 30 days or other cerebrovascular disease 1
• Recent (within 2-4 weeks) gastrointestinal or genitourinary bleeding 2, 3
• Chronic renal insufficiency (requires careful monitoring but not an absolute contraindication) 4
• Age >75 years (increased bleeding risk) 1, 3
• Body weight <75 kg (increased bleeding risk) 1, 3
• Concurrent use of other GP IIb/IIIa inhibitors 1
• Planned or likely need for urgent coronary artery bypass grafting (CABG) 1

Specific Considerations for NSTEMI Patients

• In UA/NSTEMI patients treated with bivalirudin, abciximab provides no additional benefit and increases bleeding risk 1
• Routine precatheterization laboratory (upstream) administration of abciximab is not beneficial and may increase bleeding risk 1
• Patients adequately pretreated with ticagrelor or prasugrel may not derive additional benefit from abciximab 1, 5

Appropriate Use of Abciximab in NSTEMI

• Abciximab is most beneficial in high-risk NSTEMI patients (elevated troponin) undergoing PCI who are treated with unfractionated heparin and not adequately pretreated with clopidogrel 1, 5
• In patients with high-risk NSTEMI features treated with UFH and adequately pretreated with clopidogrel, abciximab administration at the time of PCI is reasonable (Class IIa recommendation) 1
• Abciximab should not be administered to patients in whom PCI is not planned (Class III: No Benefit) 1

Risk Mitigation Strategies

• Use weight-adjusted heparin dosing (70 U/kg) when administering abciximab to reduce bleeding risk 5
• Consider early vascular sheath removal and meticulous femoral artery access site care 2, 3
• Monitor platelet counts closely during treatment due to risk of thrombocytopenia 3, 4
• For patients with chronic renal insufficiency, careful monitoring is required, but abciximab can be administered with appropriate precautions 4
• In patients at high risk of bleeding but requiring GP IIb/IIIa inhibition, consider shorter infusion duration 3

Common Pitfalls to Avoid

• Administering abciximab as upstream therapy before defining coronary anatomy (not beneficial and increases bleeding risk) 1
• Using abciximab in low-risk NSTEMI patients (TIMI risk score <2) who are already receiving dual antiplatelet therapy 1, 5
• Failing to recognize that patients with elevated troponin derive significantly greater benefit from abciximab than those without troponin elevation 5
• Administering full-dose unfractionated heparin (140 U/kg) with abciximab instead of the reduced dose (70 U/kg) 5
• Using abciximab in patients likely to need urgent CABG, as it requires 48 hours for platelet function recovery 1