What is the use of Abciximab (ReoPro)?

From the Guidelines

Abciximab should be used as an adjunct to percutaneous coronary intervention (PCI) in patients with unstable angina (UA) or non-ST-elevation myocardial infarction (NSTEMI) to reduce the risk of ischemic complications, as supported by the 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with UA/NSTEMI 1.

Key Points

• Abciximab is a glycoprotein IIb/IIIa receptor antagonist that blocks the final common pathway of platelet aggregation by preventing fibrinogen from binding to activated platelets.
• The medication is administered intravenously, typically as a 0.25 mg/kg bolus followed by a 0.125 μg/kg/min infusion (maximum 10 μg/min) for 12-24 hours after the procedure.
• Common side effects include bleeding complications, which can range from minor bruising to serious hemorrhage, and thrombocytopenia may also occur in approximately 1-2% of patients.
• Before administration, baseline complete blood count, coagulation studies, and renal function should be assessed.
• Abciximab should be used cautiously in patients with recent bleeding, surgery, or trauma, and is contraindicated in those with active internal bleeding, recent stroke, or severe uncontrolled hypertension.

Clinical Evidence

• The CAPTURE trial demonstrated that abciximab reduced the rate of death, MI, or urgent revascularization within 30 days in patients with refractory UA 1.
• The GUSTO IV-ACS trial showed that abciximab did not reduce the risk of ischemic complications in patients with UA/NSTEMI who were not undergoing PCI 1.
• The 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention recommends the use of GP IIb/IIIa inhibitors, including abciximab, in patients undergoing elective PCI with stent implantation who are at high risk of ischemic complications 1.

Recommendations

• Abciximab should be used as an adjunct to PCI in patients with UA or NSTEMI to reduce the risk of ischemic complications.
• The medication should be administered according to the recommended dosing regimen and with caution in patients with recent bleeding, surgery, or trauma.
• Patients should be closely monitored for bleeding complications and thrombocytopenia during and after treatment with abciximab.

From the Research

Overview of Abciximab

• Abciximab is a glycoprotein IIb/IIIa receptor antagonist used in patients with acute coronary syndromes undergoing percutaneous coronary interventions (PCI) 2.
• It determines a potent inhibition of platelet aggregation and thrombus formation, and its properties seem to prevent not only thrombus formation but also to promote lysis of fresh thrombus 2.

Mechanism of Action

• Abciximab binds to the vitronectin receptor on endothelial, smooth muscle, and inflammatory cells and to an activated conformation of the aMb2 receptor on leukocytes, which raises the possibility that clinical benefits derived from its use may not be exclusively due to its anti-thrombotic effect, but may also be related to the suppression of inflammatory pathways involving platelets, white blood cells, and the vascular endothelium 2.
• The local administration of abciximab at the site of coronary thrombosis may enhance, by increasing its local concentration, the binding to both platelet and endothelium receptors 2.

Clinical Benefits

• Several angiographic studies assessing the effect of intracoronary abciximab administration support on clinical grounds its adoption in patients with fresh coronary thrombosis, with better post-angioplasty coronary flow, greater degree of myocardial salvage, and a better left ventricular function recovery achieved as compared to the intravenous, systemic, administration of drug's bolus 2.
• Abciximab has been shown to reduce the risk of ischemic complications in patients undergoing PCI, and to prevent myocardial infarction in patients with unstable angina undergoing PCI 3.

Comparison with Other Glycoprotein IIb/IIIa Inhibitors

• Abciximab is not renally eliminated and does not require dosage adjustment in patients with renal insufficiency, unlike other glycoprotein IIb/IIIa inhibitors such as tirofiban and eptifibatide 4.
• The relative anti-aggregatory effects of abciximab, tirofiban, and eptifibatide during and after PCI for acute coronary syndromes have been compared, with results showing that the eptifibatide regimen inhibited platelet aggregation most consistently throughout both the early and late periods 5.

Safety and Efficacy

• The safety and efficacy of abciximab as an adjunct to PCI have been widely studied, with a large amount of information providing a clear efficacy and safety profile of the drug 6.
• The bleeding risk associated with abciximab can be controlled by the use of heparin at doses adjusted to body weight, and by applying strict precautions to protect the injection site 3.