Abstract
The use of the glycoprotein (GP) IIb/IIIa receptor antagonist Abciximab has over the years become an important part of the anticoagulant regimen in patients with acute coronary syndrome undergoing percutaneous coronary intervention. Abciximab is a potent inhibitor of platelet aggregation and thrombus formation, but other mechanisms, such as suppression of the inflammatory pathways, have also been proposed to contribute to the benefits of Abciximab.The optimal route of administration, i.e. intravenous versus intracoronary, of the first dose has been questioned, but only tested in small, non-randomised and retrospective studies or studies with short follow-up. No definite conclusion can be made based on these studies.In this review we present the current knowledge published about the intracoronary administration of Abciximab including the mechanisms behind the potential beneficial effects, and the safety. The emphasis will be on clinical trials rather than on studies on the pharmacological mechanisms, as the latter have been reviewed thoroughly elsewhere.Our conclusion from this present review is that randomized trials of intracoronary versus intravenous bolus of Abciximab are needed.
Highlights
Cardiovascular diseases are responsible for the majority of deaths in the United States [1] and Europe, and for a large proportion of the hospital expenses
In this review we present the current knowledge published about the intracoronary administration of Abciximab including the mechanisms behind the potential beneficial effects, and the safety
Atherosclerosis in the coronary arteries leading to acute coronary syndrome (ACS) accounts for the majority of cardiovascular diseases and massive resources have been put into the management of ACS
Summary
Cardiovascular diseases are responsible for the majority of deaths in the United States [1] and Europe, and for a large proportion of the hospital expenses. Along with improvement of mechanical devices such as stents, focus is directed to periprocedural anticoagulants, so-called facilitated percutaneous coronary intervention (PCI). Numerous interventional trials have proven Abciximab effective in reducing death, myocardial infarction (MI) and revascularization in patients with ACS. These trials, the first of them published in the 1990ies, and the latest ISAAR REACT 2 which was published in 2008 [2], are based on the use of intravenous (iv) Abciximab, exclusively. During the recent years, both a number of case-reports and a few smaller non randomised studies have been published, suggesting that intracoronary (ic) administration of Abciximab may be a better alternative
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