Efficacy of abciximab readministration in coronary intervention

Abciximab, on Fab monoclonal antibody fragment that blocks the platelet gly coprotein IIb/IIIa receptor, is increasingly used as an adjunct to coronary intervention. Little is known, however, about the efficacy and safely of r eadministration of abciximab. This study examined and characterized outcome s of patients receiving abciximab for a second time. From April 1995 to Jun e 1997, 164 consecutive patients were readministered abciximab at our 3 ins titutions. We retrospectively examined and analyzed in-hospital outcomes in this cohort. The median time to readministration was 95 days. The angiogra phic success rate of percutaneous intervention was 99.5%. Rates and 95% con fidence intervals of in-hospital events were death 2% (0.7% to 6.1%), myoca rdial infarction 3% (1% to 7%), coronary bypass surgery 0% (0% to 2.2%), an d intracranial hemorrhage 2% (0.4% to 5.3%). Severe thrombocytopenia was ob served in 4% of patients (1.4% to 7.8%) after readministration. Allergic or anaphylactic reactions were not observed. Major bleeding was associated wi th excessive concomitant antithrombotic therapy. patients undergoing readmi nistration of abciximab within 2 weeks of first administration experienced a higher incidence of severe thrombocytopenia (12% vs 2%, p = 0.046). Thus, abciximab remains clinically efficacious when readministered as an adjunct to percutaneous coronary intervention. However, concomitant heparin admini stration must be carefully monitored and warfarin therapy should be avoided . Vigilant surveillance for thrombocytopenia should be employed. Reduced do sing may be necessary when abciximab is readministered within days of the i nitial administration. (C) 2000 by Excerpta Medica, Inc.