Platelet inhibition and GP IIb/IIIa receptor occupancy by intracoronary versus intravenous bolus administration of abciximab in patients with ST-elevation myocardial infarction

Desch, Steffen; Siegemund, A.; Scholz, Ute; Adam, Natalie; Eitel, Ingo; Waha, Suzanne de; Fürnau, Georg; Lurz, Philipp; Wetzel, Sabrina; Schuler, Gerhard; Thiele, Holger

doi:10.1007/s00392-011-0372-6

Cited by 38 publications

(18 citation statements)

References 24 publications

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“…On the other hand, during primary PCI, the intracoronary administration of abciximab can be easily performed using a guiding catheter, which may result in a more pronounced local inhibition of platelet function and a higher degree of GP IIb/IIIa receptor occupancy when compared to standard intravenous bolus injection 65. Single cases of dethrombotic effect using an intracoronary bolus have been reported 66–68.…”

Section: Other Abciximab Administration Strategiesmentioning

confidence: 99%

Abciximab in the management of acute myocardial infarction with ST-segment elevation: evidence-based treatment, current clinical use, and future perspectives

Dziewierz¹,

Rakowski²,

Dudek³

2014

TCRM

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Introduction of antiplatelet agents has contributed substantially to improve the outcome of patients with acute coronary syndromes. Meta-analysis of the studies on abciximab administration during primary percutaneous coronary intervention (PCI) for acute ST-segment elevation myocardial infarction (STEMI) has clearly confirmed the mortality benefit associated with intravenous bolus and infusion of abciximab compared to placebo. Recently, introduction of new oral P2Y12 inhibitors (prasugrel, ticagrelor), with a faster and more pronounced antiplatelet effect, have decreased the use of abciximab even in patients with STEMI. However, recent studies have shown a delayed onset of antiplatelet effect of new oral antiplatelet drugs in the setting of STEMI, especially in patients with hemodynamic compromise. Thus, the use of abciximab as an intravenous agent should be strongly considered when oral P2Y12 inhibitors might fail or cannot be given before primary PCI for STEMI. An additional benefit of abciximab administration was reported when abciximab was given early, before primary PCI, compared to typical periprocedural use. To the contrary, no clear clinical benefit was confirmed for intracoronary administration of abciximab compared with intravenous administration. Future studies should focus on the role of abciximab given on top of new oral P2Y12 inhibitor (prasugrel, ticagrelor) or used as an alternative to an intravenous P2Y12 inhibitor (cangrelor). Undoubtedly, the results of these studies will change everyday practice of STEMI treatment.

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Section: Other Abciximab Administration Strategiesmentioning

confidence: 99%

Abciximab in the management of acute myocardial infarction with ST-segment elevation: evidence-based treatment, current clinical use, and future perspectives

Dziewierz¹,

Rakowski²,

Dudek³

2014

TCRM

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“…With a rationale that more potent ADP receptor blockers, bivalirudin, thrombus aspiration, and primary stenting are available for most of the STEMI patients and that the continuous intravenous infusion might not be benefitial to further improve outcome but increase the risk of bleeding, Gu et al [23] applied intracoronary bolus of abciximab only with no maintenance infusion and found better blush grade and reduced infact size in those with intracoronary application of abciximab. The intracoronary application of abciximab results in lower platelet reactivity in coronary sinus blood samples when compared with intravenous dosing [24]. A randomized trial comparing these regimens with/without maintenance infusion in combination with modern mechanical reperfusion devices needs to be performed.…”

Section: Pharmacotherapymentioning

confidence: 99%

Pharmaco-mechanic Antithrombotic Strategies to Reperfusion of the Infarct-Related Artery in Patients with ST-Elevation Acute Myocardial Infarctions

Kala

Miklík

2013

J. of Cardiovasc. Trans. Res.

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Primary percutaneous coronary intervention is the best treatment of patients with ST elevation myocardial infarction (STEMI). When managing a STEMI patient, our approach must be rapid and aggresive in order to interrupt the pathological process of thrombus formation and stabilization. The therapy must be initiated prior to angiography (pretreatment), continued during the procedure (periprocedural), recovery phase (in-hospital), and follow-up. The treatment strategies resulting in thrombus dissolution/extraction have focused on optimization of both pharmacological and interventional therapies. At present, there is no optimal evidence-based approach to all patients with STEMI, and the treatment of these patients needs to be modified with respect to the risk profile, availability of medical resources, and our experience. In this review, we summarize current pharmacological and interventional strategies used in the setting of STEMI and discuss potential benefits of novel dosing regimens and combinations of drugs and techniques.

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“…Recent studies showed a suboptimal platelet inhibition lasting the first 2 hours after prasugrel administration which might be obviated co-administering a bolus of GP inhibitors intravenously [58]. Therefore in the setting of STEMI patients the role of GP IIb/IIIa inhibitors is yet important, considering that intracoronary administration showed higher local receptor occupancy and improved microvascular perfusion [59-61]. …”

Section: Gp Versus Adp Inhibitorsmentioning

confidence: 99%

Is There Still a Role for Glycoprotein IIb/IIIa Antagonists in Acute Coronary Syndromes?

et al. 2013

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The role played by glycoprotein (GP) IIb/IIIa inhibitors has continuously evolved from the initial introduction in mid 90 s until the most recent guidelines for treating acute coronary syndromes, and competed with a wider use of ADP inhibitors and novel anticoagulant drugs, to the extent that they stepped down from class I to class II recommendation in the routine setting of acute coronary syndromes. As a consequence, GP IIb/IIIa use was greatly narrowed. The purpose of this review is to define the roles that GP IIb/IIIa inhibitors may still have in acute ischemic settings by explaining why in high risk patients they might be preferable and/or whether they might be added to ADP inhibitors also emphasizing the underlying mechanistic actions. It is concluded that there might be a more extensive use of GP IIb/IIIa inhibitors in patients presenting with acute coronary syndromes, strictly based on the definition for a high risk procedure: complexity, angiographic characteristics and patient’s risk profile, regardless whether STEMI or NSTEMI. The positive elements one should appreciate in GP IIb/IIIa inhibitors are: efficacy, rapid onset and reversibility of action, absence of pharmacogenomic variability, pharmacoeconomic considerations and the possibility of intracoronary administration.

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Platelet inhibition and GP IIb/IIIa receptor occupancy by intracoronary versus intravenous bolus administration of abciximab in patients with ST-elevation myocardial infarction

Abstract: Acutely, direct intracoronary bolus injection resulted in a more pronounced local inhibition of platelet function and a higher degree of GP IIb/IIIa receptor occupancy as compared to standard intravenous bolus injection.

Cited by 38 publications

References 24 publications

Abciximab in the management of acute myocardial infarction with ST-segment elevation: evidence-based treatment, current clinical use, and future perspectives

Abciximab in the management of acute myocardial infarction with ST-segment elevation: evidence-based treatment, current clinical use, and future perspectives

Pharmaco-mechanic Antithrombotic Strategies to Reperfusion of the Infarct-Related Artery in Patients with ST-Elevation Acute Myocardial Infarctions

Is There Still a Role for Glycoprotein IIb/IIIa Antagonists in Acute Coronary Syndromes?

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