Intracoronary Abciximab Administration Research Articles

Intracoronary application of abciximab in patients with ST-elevation myocardial infarction

Abciximab provides dose-dependent antiplatelet and anti-inflammatory properties. No specifically designed prospective studies have addressed the role of intracoronary bolus administration of abciximab in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). In a prospective observational study 633 STEMI patients were enrolled. After coronary angiography the filtered abciximab bolus with a concentration of 2,000 microg/mL was administered intracoronary by manual injection, followed by an intravenous infusion for 12 hours. Primary outcome measure was the cumulative rate of major adverse cardiac events (MACE) at 30 days defined as death, myocardial infarction or urgent target vessel revascularisation. Bleeding events were classified according to TIMI criteria. Patients with failed thrombolysis, cardiopulmonary resuscitation, cardiogenic shock, advanced age, or renal failure were assigned to group II; patients without those criteria were assigned to group I and compared to previous populations with intravenous bolus administration. There were no safety issues. In group I MACE occurred in 3.6% (N=16/451), major TIMI bleed in 2.0%. MACE and bleeding events were significantly less frequent in group I compared to group II (both p<0.0001). Significant predictors for MACE in multivariate statistics were assignment to group II (OR 11.69; 95%-CI 6.26-21.83; p<0.0001), post PCI TIMI 0-2 flow (OR 3.87; 95%-CI 2.02-7.44; p<0.0001) and female gender (OR 2.05; 95%-CI 1.15-3.65, p=0.014). The intracoronary administration of the abciximab bolus during PCI in STEMI patients is safe and associated with a low rate of MACE at 30 days.

Akuter thrombembolischer ST-Hebungs-Infarkt bei einem Patienten mit essenzieller Thrombozytose

A 48-year-old man presented with acute chest pain and a greatly increased platelet count. Emergency coronary angiographic revealed thrombotic occlusion of the right coronary artery. Coronary angioplasty and stenting were successfully combined with intracoronary abciximab administration. Due to inadequate postinterventional platelet inhibition an intensified dual antiplatelet therapy with acetylsalicylic acid (ASS) and clopidogrel was applied to prevent stent thrombosis. Due to the thrombo-embolic complication and a platelet count over 1 million/microl a cytoreductive treatment with hydroxyurea was initiated.

Intra-Coronary Abciximab Administration in Acute Myocardial Infarction—Results of an Ongoing, Prospective, Randomised Double-Blind Trial

Intra-Coronary Abciximab Administration in Acute Myocardial Infarction—Results of an Ongoing, Prospective, Randomised Double-Blind Trial

Rationale for intracoronary administration of abciximab

The present review aims to describe the pharmacological aspects as well as the available clinical data supporting the choice of intracoronary route of administration for abciximab, an antiplatelet drug used in patients with acute coronary syndromes undergoing percutaneous coronary interventions (PCI). Abciximab is a glycoprotein (GP) IIb/IIIa receptor antagonist which determines a potent inhibition of platelet aggregation and thrombus formation. These properties seem to prevent not only thrombus formation but also to promote (at higher drug concentration) lysis of fresh thrombus. Moreover, differently from the other GP IIb/IIIa inhibitors, abciximab also binds to the vitronectin receptor on endothelial, smooth muscle, and inflammatory cells and to an activated conformation of the aMb2 receptor on leukocytes. Such cross-reactivity 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. On such basis, 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. The results of several angiographic studies assessing the effect of intracoronary abciximab administration support on clinical grounds its adoption in patients with fresh coronary thrombosis. Indeed, better post-angioplasty coronary flow, greater degree of myocardial salvage and a better left ventricular function recovery have been achieved as compared to the intravenous, systemic, administration of drug's bolus. Condensed Abstract Several studies have highlighted the benefits of abciximab, a potent antiplatelet agent, in patients with acute coronary syndromes undergoing percutaneous coronary interventions. Moreover, differently from the other glycoprotein IIb/IIIa receptor antagonists, abciximab also has non-IIb/IIIa-related properties raising 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. Several angiographic studies in patients with fresh coronary thrombosis and recent clinical studies in patients with acute coronary syndromes undergoing mechanical revascularization support the hypothesis that local administration of abciximab at the site of the culprit coronary artery may facilitate both the de-thrombotic and the non-GP IIb/IIIa-dependent properties of the drug. On such basis, the present review aims to describe the pharmacological aspects as well as the available clinical data supporting the choice of intracoronary route of administration for abciximab.

Intracoronary Administration of Abciximab During Percutaneous Coronary Interventions: Should This Be the Routine and Preferred Approach?

The authors have had experience with administering abciximab as an intracoronary bolus in 96 high-risk patients undergoing percutaneous coronary interventions, specifically in situations in which there was anticipation of a high embolic load from thrombus/plaque burden at the site of the culprit lesion, saphenous vein graft culprit lesion, threatened abrupt closure, developing slow-flow, or no-reflow phenomena with distal embolization. Our uncontrolled data basically substantiate the safety of intracoronary administration of abciximab. The data summarizing the potential superiority of this method of administration of the drug and the likely mechanisms of this effect are summarized. These incite a need for reevaluation of the method of administration of the drug, especially in high-risk percutaneous coronary interventions cases.

Angiographic evaluation of the effect of intracoronary abciximab administration in patients undergoing urgent PCI

Background Recent data suggest that the intracoronary (IC) administration of a systemic bolus dose of abciximab during PCI may increase the efficacy of this antiplatelet drug. However, the effect of IC abciximab on coronary angiographic flow has been not clarified. Methods We studied 37 consecutive patients with acute coronary syndromes (ACS) who underwent successful urgent PCI on the target vessel and were treated by an IC abciximab bolus (0.25 mg/kg) prior to the first balloon inflation (Group IC), and 37 matched controls who were treated by intravenous (IV) abciximab bolus at the same dose (Group IV). Corrected TIMI frame count (CTFC) in the culprit and in a non-culprit coronary artery branch was assessed before treatment, immediately after intracoronary administration of abciximab bolus and at the end of the procedure. Results After administration of abciximab, CTFC significantly decreased from 48 + 37 to 33 + 30 ( P = 0.001) in the culprit vessel while in the non-culprit vessel it remained unchanged (16 + 7 pre-treatment and 16 + 7 post-treatment, P = 0.68). Final CTFC was 12 + 4 in Group IC and 14 + 5 in Group IV ( P = 0.069). Post-treatment mean peak of the cardiac enzymes showed a trend toward reduction in Group IC compared with Group IV. Conclusions The IC administration of abciximab bolus acutely decreases CTFC through culprit vessels of patients with ACS undergoing urgent PCI. Further studies evaluating the potential clinical benefits associated with IC abciximab administration are warranted.