Combination reperfusion therapy with abciximab and reduced dose reteplase:results from TIMI 14

Aims Abciximab has previously been shown to enhance thrombolysis and improv e myocardial perfusion when combined with reduced doses of alteplase. The p urpose of the reteplase phase of TIMI 14 was to evaluate the effects of abc iximab when used in combination with a reduced dose of reteplase for ST-ele vation myocardial infarction. Methods and Results Patients (n=299) with ST-elevation myocardial infarctio n were treated with aspirin and randomized to a control arm with standard d ose reteplase (10+10 U given 30 min apart) or abciximab (bolus of 0.25 mg.k g(-1) and 12-h infusion of 0.125 mug.kg(-1).min(-1)) in combination with re duced doses of reteplase (5+5 U or 10+5 U). Control patients received stand ard weight-adjusted heparin (bolus of 70 U.kg(-1); infusion of 15 U.kg(-1). h(-1)), while each of the combination arms with abciximab and reduced dose reteplase received either low dose heparin (bolus of 60 U.kg(-1); infusion of 7 U.kg(-1).h(-1)) or very low dose heparin (bolus of 30 U.kg(-1): infusi on of 4 U.kg(-1).h(-1)). The rate of TIMI 3 how at 90 min was 70% for patie nts treated with 10+10 U of reteplase alone (n=87, 73% for those treated wi th 5+5 U of reteplase with abciximab (n=88), and 77% for those treated with 10+5 U of reteplase with abciximab (n=75. Complete (greater than or equal to 70%) ST resolution at 90 min was seen in 56% of patients receiving a red uced dose of reteplase in combination with abciximab compared with 48% of p atients receiving reteplase alone. Conclusions Reduced doses of reteplase when administered in combination wit h abciximab were associated with higher TIMI 3 how rates than reported prev iously for reduced doses of reteplase without abciximab and were at least a s high as for full dose reteplase alone (C) 2000 The European Society of Ca rdiology.