Abciximab

Summary

Abciximab (ReoPro) is an intravenously administered antiplatelet agent used as an adjunct to percutaneous coronary intervention (PCI) to prevent ischemic cardiac complications. It is a chimeric Fab fragment that irreversibly blocks GPIIb/IIIa receptors, preventing platelet aggregation for the duration of platelet survival (7–10 days).

Mechanism of Action

Abciximab is the Fab fragment of the chimeric human-murine monoclonal antibody 7E3. It binds with high affinity to the glycoprotein IIb/IIIa (GPIIb/IIIa) receptor on platelets, blocking fibrinogen, von Willebrand factor, and other adhesion molecules from binding, thereby inhibiting platelet aggregation. It also binds to the vitronectin receptor (αvβ3) on platelets and vascular endothelial cells.

Routes of Administration

Goals & Uses

• Adjunct in primary PCI for STEMICardiovascular / Acute Coronary SyndromeModerate
• Adjunct therapy in unstable angina refractory to conventional treatmentCardiovascular / AntiplateletHigh
• Reduction of acute myocardial infarction in PCI patientsCardiovascularHigh
• Stent thrombosis preventionCardiovascular / Interventional CardiologyHigh
• Prevention of ischemic complications during PCICardiovascular / AntiplateletHigh

Contraindications

• Oral anticoagulant therapy within 7 days (unless PT ≤1.2× control)Drug Interaction / Bleeding RiskHigh
• History of stroke within 2 years or any stroke with significant residual neurological deficitNeurological / Bleeding RiskHigh
• Known hypersensitivity to murine proteins or abciximabImmunologicalHigh
• Active internal bleedingBleeding RiskHigh
• Thrombocytopenia (platelet count < 100,000 cells/μL)HematologicalHigh
• Recent major surgery or trauma (within 6 weeks)Surgical / Bleeding RiskHigh

Adverse Effects

• Nausea / VomitingGastrointestinalCommon
• Hypersensitivity / anaphylaxisImmunologicalRare
• ThrombocytopeniaHematologicUncommonLow platelet count
• Bleeding (major and minor)HematologicalCommon
• HypotensionCardiovascularCommonLow blood pressure
• Back painMusculoskeletalCommonPain in the back

Drug Interactions

• DextranModerate
• Oral antiplatelet agents (aspirin, clopidogrel)Moderate
• Low molecular weight heparins (LMWH)Moderate
• Thrombolytics (e.g., alteplase, streptokinase)High
• Unfractionated HeparinHigh
• Other GPIIb/IIIa inhibitors (e.g., eptifibatide, tirofiban)High

Population Constraints

• PregnancyReproductive SafetyRelative
• Renal impairmentOrgan ImpairmentRelative
• Prior abciximab exposureImmunologicalRelative
• Pediatric patientsAgeRelative
• Elderly patients (≥65 years)Age RelatedRelative

Regulatory Status

• European UnionApprovedApproved: Prevention of ischemic cardiac complications in adults undergoing PCI, Short-term reduction of risk of myocardial infarction in patients with unstable angina prior to planned PCIApproved by EMA; marketing authorization holder has varied; availability limited in some EU markets.
• United StatesApprovedApproved: Adjunct to PCI for prevention of cardiac ischemic complications, Unstable angina not responding to conventional medical therapy when PCI is planned within 24 hoursFDA-approved since December 1994 (NDA 103575). Manufactured by Eli Lilly/Centocor (now Janssen). Market availability has declined.
• United KingdomApprovedApproved: Adjunct to PCI for prevention of ischemic cardiac complications, Short-term risk reduction in unstable angina prior to planned PCIApproved via EMA prior to Brexit; MHRA recognizes prior authorization. Availability may be limited.

FDA-approved since 1994 for use in PCI and unstable angina refractory to conventional therapy. The European Medicines Agency (EMA) has also granted approval. Use has declined with the advent of newer antiplatelet agents and drug-eluting stents.

Evidence & Sources

No sources recorded yet.