Abciximab
Class: Platelet-aggregation Inhibitors
- Antithrombotic Agents
- Platelet-aggregation Inhibitors
- GP IIb/IIIa Receptor Inhibitors
Chemical Name: Human mouse monoclonal c7E3 clone p7E3VHhCgamma4 Fab fragment anti-human glycoprotein IIb/IIIa receptor immunoglobulin G disulfide with human-mouse monoclonal c7E3 clone p7E3vkhCk light chain
CAS Number: 143653-53-6
Brands: ReoPro
Introduction
Platelet aggregation inhibitor; a platelet glycoprotein (GP IIb/IIIa)-receptor inhibitor.
Uses for Abciximab
Acute Ischemic Complications of PCI
Adjunct to anticoagulant therapy (e.g., heparin [referring throughout this monograph to unfractionated heparin], low molecular weight heparin), aspirin, and a P2Y12 platelet adenosine diphosphate (ADP)-receptor antagonist (e.g., clopidogrel, prasugrel, ticagrelor) to prevent acute cardiac ischemic complications in patients undergoing PCI or in patients with non-ST-segment-elevation acute coronary syndromes (NSTE ACS; unstable angina or non-ST-segment-elevation MI [NSTEMI]) not responding to conventional medical therapy in whom PCI is planned within 24 hours.
Adjunctive therapy with a GP IIb/IIIa-receptor inhibitor can reduce the incidence of cardiac ischemic events, including subsequent MI and death, in patients with NSTE ACS undergoing PCI and in patients without these conditions undergoing PCI.
Safety and efficacy in patients not undergoing PCI not established.
The American College of Cardiology Foundation (ACCF), AHA, the Society for Cardiovascular Angiography and Interventions (SCAI), and other experts currently do not recommend routine use of GP IIb/IIIa-receptor inhibitors in patients with ST-segment elevation MI (STEMI) undergoing PCI; however, selective use of these drugs as an adjunct to heparin may be reasonable in certain high-risk patients (e.g., those with large anterior MI and/or large thrombus).
ACCF/AHA/SCAI state that administration of a GP IIb/IIIa-receptor inhibitor at the time of PCI as an adjunct to heparin may be particularly useful in patients with NSTE ACS who have high-risk features (e.g., elevated troponin) and are not receiving bivalirudin and are not adequately pretreated with clopidogrel.
Regarding choice of GP IIb/IIIa-receptor inhibitor in patients undergoing PCI, IV abciximab, “double-bolus” IV eptifibatide, and high-dose tirofiban given by direct IV injection all produce a high degree of platelet inhibition and reduce ischemic complications.
Non-ST-Segment-Elevation Acute Coronary Syndromes
Has been used in patients with unstable angina or NSTEMI (i.e., NSTE ACS) managed with conservative medical therapy only†; however, manufacturer and some clinicians state that safety and efficacy of abciximab not established in such patients who are not undergoing PCI.
A GP IIb/IIIa-receptor inhibitor may be used in conjunction with aspirin prior to diagnostic angiography (“upstream”) in patients with NSTE ACS in whom an initial invasive management strategy is planned; however, IV eptifibatide or tirofiban is the preferred GP IIb/IIIa inhibitor for
