Abciximab

Indications

Abciximab is used for: Unstable Angina, Adjunct to PCI

Adult Dose

Intravenous Stabilisation in patients with unstable angina Adult: In conjunction with heparin and aspirin: Patients with scheduled PCI within 24 hours: 250 mcg/kg as a bolus inj over 1 minute followed by 0.125 mcg/kg/min (max: 10 mcg/min) continuous infusion; bolus dose followed by infusion should be started up to 24 hours prior to possible PCI and concluded 12 hours after. Adjunct in the prophylaxis of acute ischaemic complications in percutaneous coronary intervention Adult: In conjunction with heparin and aspirin: 250 mcg/kg as a bolus inj over 1 minute to be given 10-60 minutes prior to PCI followed by 0.125 mcg/kg/min (max: 10 mcg/min) continuous infusion for 12 hours. Hepatic impairment: Severe: Contraindicated.

Child Dose

Renal Dose

Renal impairment: Severe (requiring haemodialysis): Contraindicated.

Administration

Contra Indications

Active internal bleeding or recent (w/in 6 wk) clinically-significant GI or genitourinary bleeding; history of CVA w/in 2 yr or CVA w/ significant residual neurological deficit; clotting abnormalities; recent (w/in 2 mth) intracranial or intraspinal surgery or trauma; recent (w/in 2 mth) major surgery; intracranial neoplasm, arteriovenous malformation or aneurysm; known bleeding diathesis or severe uncontrolled HTN; pre-existing thrombocytopenia; vasculitis; hypertensive retinopathy. Severe renal impairment requiring haemodialysis and severe hepatic impairment. Concomitant use of oral anticoagulants w/in 7 days (unless prothrombin time (PT) is ≤1.2 times the control PT value). IV admin of dextran before PCI or intent to use it during an intervention.

Precautions

Patient w/ haemorrhagic retinopathy, acute pericarditis, aortic dissection. Severe renal impairment. Pregnancy and lactation. Monitoring Parameters Monitor platelet count at baseline, 2-4 hr after bolus infusion, and at 24 hr; prothrombin time, aPTT, Hb, haematocrit, fibrinogen, fibrin split products, transfusion requirements, signs of hypersensitivity reactions, guaiac stools

Pregnancy-Lactation

Pregnancy Category: C Lactation: not known if excreted in breast milk; use caution

Interactions

Increased risk of bleeding w/ other antiplatelet drugs or thrombolytics. Potentially Fatal: Major bleeding episodes may occur w/ concomitant oral anticoagulants or IV admin of dextran.

Side Effects

Side effects of Abciximab : >10% Bleeding, minor (70-82%) Bleeding, major (17-21%) Hypotension (14-21%) Back pain (17.6%) Nausea (13.6%) Chest pain (11.4%) Vomiting (7-11%) 1-10% Headache (6%) Thrombocytopenia (2-6%) Bradycardia (5%) Injection site pain (3.6%) Extremity pain (3.5%) Abdominal pain (3%) UTI (2%) Dizziness (1.8%) Peripheral edema (1.6%) Anemia (1.2%) Diarrhea (1%) Hypoesthesia (1%)

Mode of Action

Abciximab is the Fab fragment of the chimeric monoclonal antibody 7E3 which binds to glycoprotein (GP) IIb or IIIa receptor on platelet surface, thus preventing binding of fibrinogen, von Willebrand factor, and other adhesive molecules to the receptor sites, leading to inhibition of platelet aggregation.