Abciximab

Abciximab

ReoPro

Classification

Antiplatelet, Glycoprotein IIB/IIIA inhibitor

 

Therapeutic action

Abciximab is a human-murine monoclonal antibody Fab (fragment antigen binding) fragment. The drug
binds to the glycoprotein IIb/IIIa (GPIIb/IIIa) receptor sites of platelets.
Mechanism of action – it inhibits platelet aggregation by preventing fibrinogen, von Willebrand’s factor, and other
molecules from adhering to GPIIb/ IIIa receptor sites of the platelets.

Pregnancy category

C

 

Uses, Indications

The drug is used as an adjunct to aspirin and heparin for the prevention of acute cardiac ischemic complications in patients undergoing percutaneous transluminalcoronary angioplasty (PTCA).
Unlabeled uses of the drug include:  Acute MI, Kawasaki disease.

Contraindications
  • Hypersensitivity to abciximab or to murine proteins
  • Active internal bleeding GI or GU bleeding within 6 wk
  • history of CVA within 2 y or a CVA with severe neurologic deficit
  • Thrombocytopenia (less than 100,000 cells/ mL)
  • Recent major surgery or trauma
  • Intracranial neoplasm
  • Aneurysm,
  • Severe hypertension
  • History of  vasculitis
  • Use of dextran before or during PTCA
Use cautiously
  • If patient is weighing less than 75 kg
  • If there is a history of previous GI disease
  • If there is a history of recent thrombolytic therapy
  • If PTCA within 12 h of myocardial infarction
    If unsuccessful PTCA
  • If PTCA procedure is lasting longer than 70 minutes
  • In older adults
  • In pregnancy ( drug belongs to category C)
  • If lactating mother
  • Safe use in children of abciximab has not been established.

 

Side effects
  • Hematologic complications: Bleeding, including intracranial, retroperitoneal bleeding, and hematemesis.
  • Thrombocytopenia
Administration

Intravenous administration

  • Do not shake vial. Discard if visible opaque particles are noted.
  • A nonpyrogenic low proteinbinding 0.2- or 0.22-micron filter should be used.
  • Should be infused through separate IV line.
  • Y-site: Should be infuse through separate IV line.
Pharmacokinetics

Onset: Greater than 90% inhibition of platelet aggregation within 2 hours
Duration: Approximately 48 hours
Half-Life: 30 minutes

Interactions
  • Concomitant use with oral anticoagulants, NSAIDS, dipyridamole, ticlopidine, dextran and abciximab may
    increase risk of bleeding.
  • Concomitant use with Gingko biloba can increase the  risk of bleeding.
Nursing implications

 

Monitor
  • Patient should be monitored for the signs and symptoms of bleeding at all potential sites: including catheter
    insertion, needle puncture, or cutdown sites; GI, GU, or retroperitoneal sites.
  • Patient should be monitored for signs and symptoms of hypersensitivity that may occur any time during
    administration of the drug.
  • It is recommended to avoid or minimize unnecessary invasive procedures and devices to reduce risk of bleeding.
  • The head of bed should be elevated 30° or less and  limbs should be kept straight when femoral artery access is used.
  • When following sheath removal, the pressure should be applied for 30 minutes.
    Infusion should be stopped immediately and  prescriber should be notified  if bleeding or signs and symptoms of hypersensitivity occurs.

Monitor lab tests:

  • Baseline platelet count, PT, aPTT, and ACT, then repeat every 2–4 h during first 24 h
  • aPTT or ACT prior to arterial sheath removal (should not remove unless a PTT is 50 sec or less or ACT is 75 sec or less).
Patient and Family education

Signs and symptoms of bleeding should be reported immediately to the nursing staff.

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