Classification: Antiplatelet agent
Action/Kinetics: Abciximab is the Fab fragment of the chimeric human-murine monoclonal antibody 7E3. It binds to a glycoprotein receptor on human platelets, thus inhibiting platelet aggregation by preventing the binding of fibrinogen, von Willebrand factor, and other adhesive molecules to receptor sites on activated platelets. t 1/2, after IV bolus: 30 min. Recovery of platelet function: About 48 hr, although the drug remains in the circulation bound to platelets for up to 10 days. Following IV infusion, free drug levels in the plasma decrease rapidly for about 6 hr and then decline at a slower rate.
Uses: Inhibition of platelet aggregation. Adjunct to percutaneous transluminal coronary angioplasty or atherectomy for prophylaxis of acute cardiac ischemic complications in clients at high risk for abrupt closure of the treated coronary vessel. Used with aspirin and heparin. Adjunct with heparin to prevent cardiac ischemic complications in those undergoing PCI; also, for unstable angina clients not responding to conventional therapy when PCI is scheduled within 24 hr.
Contraindications: Due to a potential for drug-induced bleeding, abciximab is contraindicated as follows: history of CVA (within 2 years) or CVA with a significant residual neurologic deficit; active internal bleeding; within 6 weeks of GI or GU bleeding of clinical significance; bleeding diathesis; within 7 days of administration of oral anticoagulants unless the PT is less than 1.2 times control; thrombocytopenia (less than 100,000 cells/üL); within 6 weeks of major surgery or trauma; intracranial neoplasm; arteriovenous malformation or aneurysm; severe uncontrolled hypertension; presumed or documented history of vasculitis; use of IV dextran before atherectomy or intent to use it during atherectomy; hypersensitivity to murine proteins.
Special Concerns: Assess benefits versus the risk of increased bleeding in clients who weigh less than 75 kg, are 65 years of age or older, have a history of GI disease, are receiving thrombolytics, and are receiving heparin. The following conditions are also associated with an increased risk of bleeding in the angioplasty setting and which may be additive to that of abciximab: atherectomy within 12 hr of onset of symptoms for acute MI, atherectomy lasting more than 70 min, and failed atherectomy. Use with caution when abciximab is used with other drugs that affect hemostasis, including thrombolytics, oral anticoagulants, NSAIDs, dipyridamole, and ticlopidine. Use with caution during lactation. Safety and efficacy have not been determined in children.
Side Effects: CV: Increased bleeding tendencies hypotension, bradycardia, atrial fibrillation or flutter, vascular disorder, pulmonary edema, complete AV block supraventricular tachycardia, weak pulse, palpitations, intermittent claudication, pericardial effusion, limb embolism, pulmonary embolism, ventricular arrhythmia. GI:N&V, diarrhea, constipation, ileus. Hematologic: Thrombocytopenia, anemia, leukocytosis, hemolytic anemia, petechiae. CNS: Hypesthesia, confusion, abnormal thinking, dizziness, coma, brain ischemia insomnia. Respiratory: Pleural effusion, pleurisy, pneumonia. Musculoskeletal: Myopathy, cellulitis, myalgia. GU: Urinary tract infection, urinary retention, abnormal renal function. Miscellaneous: Pain, peripheral edema, abnormal vision, development of human antichimeric antibody, dysphonia, pruritus.
How Supplied: Injection: 2 mg/mL