abciximab

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abciximab

 [ab-sik´sĭ-mab]
a human-murine monoclonal antibodyFab fragment that inhibits the aggregation of platelets, used in prevention of thrombosis in percutaneous transluminal coronary angioplasty; administered by intravenous infusion.

abciximab

ReoPro (CA)

Pharmacologic class: Platelet aggregation inhibitor

Therapeutic class: Antithrombotic, antiplatelet drug

Pregnancy risk category C

Action

Inhibits fibrinogen binding and platelet-platelet interaction by impeding fibrinogen binding to platelet receptor sites, thereby prolonging bleeding time

Availability

Injection: 2 mg/ml (5-ml vials containing 10 mg)

Indications and dosages

Adjunct to aspirin and heparin to prevent acute cardiac ischemic complications in patients undergoing percutaneous coronary intervention (PCI)

Adults: 0.25 mg/kg I.V. bolus given 10 to 60 minutes before start of PCI, followed by infusion of 0.125 mcg/kg/minute for 12 hours. Maximum dosage is 10 mcg/minute.

Adjunct to aspirin and heparin in patients with unstable angina who haven't responded to conventional medical therapy and will undergo PCI within 24 hours

Adults: 0.25 mg/kg I.V. bolus, followed by 18- to 24-hour infusion of 10 mcg/minute, ending 1 hour after PCI

Contraindications

• Hypersensitivity to drug or murine proteins
• Active internal bleeding
• Bleeding diathesis
• Severe, uncontrolled hypertension
• Thrombocytopenia (< 100,000 cells/mm3)
• Neutropenia
• Aneurysm
• Arteriovenous malformation
• History of cerebrovascular accident
• Oral anticoagulant therapy within past 7 days (unless prothrombin time is < 1.2 times control)

Precautions

Use cautiously in:
• patients receiving drugs that affect hemostasis (such as thrombolytics, anticoagulants, or antiplatelet drugs)
• pregnant or breastfeeding patients.

Administration

• I.V. bolus dose may be given undiluted. For I.V. infusion, further dilute the desired dose with normal saline or D5W.
• Give through separate I.V. line with no other drugs.
• Avoid noncompressible I.V. sites, such as subclavian or jugular vein.

Stop continuous infusion after failed PCI.
• Restrict patient to bed rest for 6 to 8 hours after drug withdrawal or 4 hours after heparin withdrawal (whichever occurs first).
• After catheter removal, apply pressure to femoral artery for at least 30 minutes.

Adverse reactions

CNS: dizziness, anxiety, agitation, abnormal thinking, hypoesthesia, difficulty speaking, confusion, weakness, cerebral ischemia, coma

CV: pseudoaneurysm, palpitations, vascular disorders, arteriovenous fistula, hypotension, peripheral edema, weak pulse, intermittent claudication, bradycardia, ventricular or supraventricular tachycardia, atrial fibrillation or flutter, atrioventricular block, nodal arrhythmias, pericardial effusion, embolism, thrombophlebitis

EENT: abnormal or double vision

GI: nausea, vomiting, diarrhea, constipation, dyspepsia, ileus, gastroesophageal reflux, enlarged abdomen, dry mouth

GU: urinary tract infection, urine retention or urinary incontinence, painful or frequent urination, abnormal renal function, cystalgia, prostatitis Hematologic: anemia, leukocytosis, thrombocytopenia, bleeding

Metabolic: diabetes mellitus, hyperkalemia

Musculoskeletal: myopathy, myalgia, increased muscle tension, reduced muscle stretching ability

Respiratory: pneumonia, crackles, rhonchi, bronchitis, pleurisy, pleural effusion, bronchospasm, pulmonary edema, pulmonary embolism

Skin: pallor, cellulitis, petechiae, pruritus, bullous eruptions, diaphoresis

Other: abscess, peripheral coldness, development of human antichimeric antibodies

Interactions

Drug-drug.Drugs that affect hemostasis (such as aspirin, dextran, dipyridamole, heparin, nonsteroidal anti-inflammatory drugs, oral anticoagulants, thrombolytics, and ticlopidine): increased bleeding risk

Drug-diagnostic tests.Activated partial thromboplastin time (APTT), clotting time, prothrombin time (PT): increased values

Platelets: decreased count

Patient monitoring

• Assess platelet count before, during, and after therapy.

Monitor catheter insertion site frequently for bleeding.

During catheter insertion and for 6 hours after catheter removal, frequently monitor digital pulse in leg where catheter was inserted.
• Monitor CBC, PT, APTT, and International Normalized Ratio.
• Minimize arterial or venous punctures, automatic blood pressure cuff use, I.M. injections, nasotracheal or nasogastric intubation, and urinary catheterization.
• Use indwelling venipuncture device, such as heparin lock, to draw blood.

Patient teaching

• Tell patient what to expect during and after drug administration.
• Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.

Instruct patient to immediately report unusual bleeding or bruising.
• Caution patient to avoid activities that may cause injury. Advise him to use soft toothbrush and electric razor to avoid gum and skin injury.
• Inform patient that he'll undergo regular blood testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.

abciximab

/ab·cix·i·mab/ (ab-sik´sĭ-mab) a human-murine monoclonal antibody Fab fragment that inhibits the aggregation of platelets, used as an antithrombotic in percutaneous transluminal coronary angioplasty.

abciximab

(ăb-sĭk′sə-măb′)
n.
A monoclonal antibody with anticoagulant properties, used to reduce the risk of heart attacks and other ischemic complications during coronary angioplasty.

abciximab

[ab-sik′si-mab]
a human-murine monoclonal antibody Fab fragment that inhibits the aggregation of platelets, used in the prevention of thrombosis in percutaneous transluminal coronary angioplasty, administered by intravenous infusion.
indications It is prescribed as an adjunct to percutaneous transluminal coronary angioplasty or atherectomy.
contraindications The drug should not be given to patients with active internal bleeding, recent GI or urinary bleeding of significance, history of stroke, thrombocytopenia, or recent major surgery.
adverse effects The side effects most often reported include bleeding, thrombocytopenia, pulmonary edema, atrioventricular block, and atrial fibrillation.

abciximab

ReoPro® Cardiology A proprietary–Eli Lilly monoclonal antibody directed against platelet glycoprotein IIb/IIIb, as an adjunct for PTCA or atherectomy to ↓ coronary artery ischemia, in Pts with unstable angina not responding to conventional medical therapy See EPILOG.

abciximab

A monoclonal antibody drug that inhibits the platelet glycoprotein IIb/IIIa receptor and is used as an adjunct to heparin and aspirin in patients undergoing coronary angioplasty. It is also used for the short-term protection of patients wit unstable angina. The drug has been found valuable in coronary stenting. A brand name is Reopro.

antiplatelet therapy

agents that reduce platelet aggregation and inhibit arterial thrombus formation in an area of the circulation where other anticoagulants have reduced effect; e.g. low-dose aspirin (75 mg daily), clopidogrel (± low-dose aspirin), dipyridamole (used to prevent thromboembolism in patients with prosthetic heart valves), abciximab, eptifibatide and tirofiban