Thrombus Aspiration Plus Intracoronary Abciximab vs Intracoronary Abciximab Alone in Patients with STEMI Undergoing Primary PCI

Background: Thrombus embolization during the Percutaneous Coronary Intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) is common and results in suboptimal myocardial perfusion and increased infarct size. Two strategies proposed to reduce distal embolization and improve outcomes after primary PCI is bolus intracoronary Abciximab and manual aspiration thrombectomy. There are several factors which influence the decision of primary PCI in a patient with AMI in developing countries. Cost of therapy and affordability is probably the most important factor. The additional cost for thrombus aspiration needs to be considered against the additional advantages in terms of better clinical outcome. Objectives: To compare the use of a combination of intracoronary Abciximab with manual thrombus aspiration to intracoronary Abciximab alone, in patients with STEMI undergoing primary PCI. Patients and Methods: This is a prospective observational study of patients with STEMI who underwent primary PCI between June 2018 to May 2019. A pre-approved study protocol was designed to determine the eligibility of STEMI patients to be included in the study. Patients with The patients have analysed in two groups: 84 patients received a combination of intracoronary Abciximab with manual thrombus aspiration & 80 patients received intracoronary Abciximab alone. The primary endpoint was the assessment of myocardial perfusion parameters namely Myocardial Blush Grade (MBG) in the culprit vessel & ST-segment resolution of >70% on ECG at 90 min after PCI. Secondary endpoints were the improvement in LV ejection fraction, cardiovascular mortality & recurrent MI at one-month post-procedure. Results: Result of the 84 patients who received combination of intracoronary Abciximab with manual thrombus aspiration, the primary endpoints namely the myocardial blush grade (MBG) of 2/3 was achieved in 72 patients (90.74%) & ST-segment resolution of >70% at 90 min was seen in 66 patients (78.57%) (p<0.001). Of the 80 patients who received only intracoronary Abciximab without thrombus aspiration, MBG 2/3 was achieved in 38 patients (47.5%) & ST-segment resolution of >70% at 90 min was seen in 28 patients (35%). At one month of follow up the secondary endpoints namely the LVEF in the combination group improved from 43.42±3.73 to 47.88±4.16% (p=0.12)and in the Abciximab group improved from 44.78±3.34 to 46.20±3.63%. Recurrent MI was seen in one patient in the combination group (p<0.001) & two patients in the ic Abciximab group. There was no cardiovascular mortality noted in the present study (p<0.001). Conclusion: Intracoronary Abciximab + manual thrombus aspiration reduces thrombus burden with better results in microvascular perfusion assessed by ST-segment resolution of >70% at 90 min & higher Myocardial Blush Grade compared to intracoronary Abciximab alone in patients with STEMI undergoing primary PCI.

Bilateral subconjunctival hemorrhage secondary to abciximab use: case report

ABSTRACT CONTEXT: There are no reports on cases of subconjunctival hemorrhage due to use of glycoprotein IIb/IIIa inhibitors. In this report, we present the case of a patient with bilateral subconjunctival hemorrhage after receiving abciximab. CASE REPORT: A 40-year-old male patient underwent coronary angiography after acute anterior myocardial infarction and a coronary stent was placed. Abciximab was added to the therapy because of stent thrombosis. Bilateral subconjunctival hemorrhage was observed after the administration of the abciximab treatment. We treated our patient by stopping abciximab and administering artificial tears. CONCLUSİON: For the first time in the literature, we presented the case of a patient with bilateral subconjunctival hemorrhage after receiving abciximab, which was managed conservatively.

Spontaneous Bleeding from Internal Pudendal Artery associated with Abciximab after Primary Percutaneous Coronary Intervention: Successful Treatment with Percutaneous Gel-Foam Embolization

We describe a case of spontaneous bleeding from a branch of the right internal pudendal artery that resulted in massive scrotal swelling in a patient who had underwent primary percutaneous coronary intervention with the use of abciximab concurrent with conventional anticoagulation and dual antiplatelet therapies for the treatment of acute ST-segment elevation myocardial infarction. This unusual complication was promptly identified by percutaneous peripheral arteriography and successfully treated with gel-foam embolization.

Meta-analysis of therapeutic effect and safety of intracoronary abciximab treatment on patients with ST-elevation myocardial infarction / 心血管康复医学杂志

Objective:To compare therapeutic effects and safety of intracoronary (IC ) abciximab and intravenous (IV) abciximab on ST‐elevation myocardial infarction (STEMI) . Methods:The databases of PubMed ,Cochrane Central Register of Controlled Trials ,Chinese Biomedical Literature Database (CBM) and CNKI were retrieved on computers for collecting randomized controlled trials (RCTs) about comparison of therapeutic effects between IC abciximab and IV abciximab published from Jan 1993 to Jun 2014. At the same time ,the data included literature , conference abstracts and related websites were retrieved manually .The data of eligible RCTs were extracted and re‐ceived meta‐analysis using RevMan5.0 software .Results:A total of seven RCTs were enrolled .Meta‐analysis indi‐cated that incidence rate of recurrent myocardial infarction in IC abciximab group was significantly lower than that of IV abciximab group (OR= 0.61 ,95% CI:0.40~0.92 , P=0.02 );there were no significant difference in all‐cause mortality (OR=0.85 ,95% CI :0.59~1.23 ,P=0.39) ,target vessel revascularization rate (OR=0.66 ,95%CI :0.40~1.09 , P=0.10) and incidence rate of major bleeding (OR=1.00 ,95% CI :0.68~1.47 , P=0.99) be‐tween IC abciximab group and IV abciximab group . Conclusion:The IC abciximab can more significantly reduce in‐cidence rate of recurrent myocardial infarction in STEMI patients .

Acute Stent Thrombosis after Coronary Stenting in Patients with Acute Coronary Syndrome

Acute stent thrombosis after percutaneous coronary intervention (PCI) is still problematic because of the subsequent development of myocardial infarction and poor prognosis. The incidence of acute stent thrombosis, occurring within 0-24hours after PCI, is relatively low, but underlying causes and treatment strategy are not well defined. Multi-vessel disease, ST-elevated myocardial infarction (STEMI), and large thrombotic burden are known risk factors of acute stent thrombosis. Thrombus aspiration, balloon angioplasty and glycoprotein IIb/IIIa receptor blocker could be therapeutic options. Recently we experienced two cases of acute stent thrombosis which developed during PCI with the aggravation of chest pain, and acute stent thrombosis were diagnosed immediately and successfully treated. Here we report two cases of acute stent thrombosis during PCI for one patient with STEMI and the other with acute coronary syndrome, which were successfully treated with thrombus aspiration and intravenous infusion of glycoprotein IIb/IIIa receptor blocker.

Efficacy of Combination Treatment with Intracoronary Abciximab and Aspiration Thrombectomy on Myocardial Perfusion in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Primary Coronary Stenting

PURPOSE: We aimed to investigate whether combination therapy using intracoronary (IC) abciximab and aspiration thrombectomy (AT) enhances myocardial perfusion compared to each treatment alone in patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). MATERIALS AND METHODS: We enrolled 40 patients with STEMI, who presented within 6 h of symptom onset and had Thrombolysis in MI flow 0/1 or a large angiographic thrombus burden (grade 3/4). Patients were randomly divided into 3 groups: 10 patients who received a bolus of IC abciximab (0.25 mg/kg); 10 patients who received only AT; and 20 patients who received both treatments. The index of microcirculatory resistance (IMR) was measured with a pressure sensor/thermistor-tipped guidewire following successful PCI. Microvascular obstruction (MVO) was assessed using cardiac magnetic resonance imaging on day 5. RESULTS: IMR was lower in the combination group than in the IC abciximab group (23.5+/-7.4 U vs. 66.9+/-48.7 U, p=0.001) and tended to be lower than in the AT group, with barely missed significance (23.5+/-7.4 U vs. 37.2+/-26.1 U, p=0.07). MVO was observed less frequently in the combination group than in the IC abciximab group (18.8% vs. 88.9%, p=0.002) and tended to occur less frequently than in the AT group (18.8% vs. 66.7%, p=0.054). No difference of IMR and MVO was found between the IC abciximab and the AT group (66.9+/-48.7 U vs. 37.2+/-26.1 U, p=0.451 for IMR; 88.9% vs. 66.7%, p=0.525 for MVO, respectively). CONCLUSION: Combination treatment using IC abciximab and AT may synergistically improve myocardial perfusion in patients with STEMI undergoing primary PCI (Trial Registration: clinicaltrials. gov Identifier: NCT01404507).

Intracoronary abciximab administration for patients undergoing percutaneous coronary intervention:a meta-analysis of randomized trials / 重庆医学

Objective To systematically evaluate the efficacy and safety of intracoronary abciximab administration as compared to intravenous in percutaneous coronary intervention (PCI) .Methods A search was conducted in PubMed ,EMBASE ,OVID ,CBM , CNKI and VIP for the randomized controlled trials (RCTs)of intracoronary abciximab administration versus intravenous in PCI , from the date of their establishment to September 30 ,2013 ,and the domestic relevant papers published in recent 1 year were also searched manually ,the bibliographies of the included studies were searched too .According to the criteria of the cochrane Hand-book ,two reviewers evaluated the quality of the included RCTs and extracted data independently ,and then the extracted data were analyzed by using RevMan 5 .1 software .Results 8 RCTs involving 10 articles with 4 150 patients who treated with PCI were in-cluded .The results of meta-analysis showed that :(1) Compared intravenous administration and intracoronary abciximab administra-tion ,there were no significant differences in the two groups for the major adverse cardiovascular event (MACE) and the mortality (OR=0 .78 ,95% CI 0 .54-1 .14 ,P=0 .20) ,(OR=0 .56 ,95% CI 0 .24-1 .30 ,P=0 .18) .(2)Compared with intravenous adminis-tration ,intracoronary abciximab administration were not associated with any excess of major bleeding complications :(OR=1 .26 , 95% CI 0 .78-2 .02 ,P=0 .35) .Conclusion Compared with standard abciximab regimen of intravenous bolus ,intracoronary admin-istration had equivalent effects in clinical outcomes in patients undergoing PCI ,and did not increase the incidence of bleeding events .

Acute Profound Thrombocytopenia after Using Abciximab for No-Reflow during Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

Glycoprotein IIb/IIIa antagonists are well established for their effectiveness in improving clinical outcomes in acute coronary syndrome patients undergoing percutaneous coronary intervention. Acute profound thrombocytopenia is a rare complication of abciximab. We present a case which was managed successfully for the rare complication of acute profound thrombocytopenia after using abciximab and an intra-aortic balloon pump for the treatment of a no-reflow phenomenon and consecutive cardiogenic shock during primary percutaneous coronary intervention.

Anterior Mediastinal Hematoma after Cardiopulmonary Resuscitation

Anterior mediastinal hematoma is often reported as a complication of cardiopulmonary resuscitation (CPR). CPR can be performed as a result of myocardial infarction, and early percutaneous coronary intervention (PCI) and anticoagulant, antiplatelet agent can improve outcome. As use of antiplatelet agents, like glycoprotein IIb/IIIa inhibitors, becomes more widespread, occurrence of complications such as bleeding may be increased. The mediastinal hematoma usually resolves itself without complications; however, a large amount of hematoma can cause cardiac tamponade. Therefore, rapid diagnosis is very important. We describe a case of anterior mediastinal hematoma detected by echocardiography after CPR and PCI.

Trombocitopenia aguda profunda asociada al uso de abciximab: a propósito de un caso / Acute profound thrombocytopenia associated with the use of abciximab: case report

Se presenta un paciente con angina inestable e intervención coronaria percutánea con stents, que desarrolló púrpura mucocutánea y hematoma inguinal asociados a trombocitopenia aguda profunda inducida por abciximab con nadir de 1 x 10(9)/L (1000 plaquetas/mm³), su recuperación con el tratamiento instituido y la complicación de trombosis subaguda intrastent asociada a cuenta plaquetaria funcional que requirió reintervención con angioplastía primaria y administración de tirofiban, un agente bloqueador del receptor IIb/IIIa diferente. Se realizaron estudios diagnósticos para investigar otras causas de trombocitopenia en estos pacientes que reciben heparina, antiplaquetarios como ácido acetilsalicílico y clopidogrel, asociados a bloqueadores del receptor IIb/IIIa. Se realizó una revisión de publicaciones con reporte de esta complicación.

We present the case-report of a patient with instable angina who submitted to percutaneous coronary intervention and stent place for revascularization who developed purpura and groin hematoma associated to acute profound thrombocytopenia induced by abciximab infusion with nadir platelet counts 1 x 10(9)/L (1,000 platelets/mm³), his platelet recovery with the instituted treatment and the outcome with subacute intra-stent thrombosis that was associated with functionally platelet counts that required a primary angioplasty and administration of tirofiban, a platelet glycoprotein IIb/IIIa receptor antagonist. Laboratory confirmation to exclude other causes of thrombocytopenia and its association of glycoprotein IIb/IIIa receptor antagonist with heparin, acetylsalicylic acid and clopidogrel were obtained. We perform in literature trials with this complication.

Current status of glycoprotein IIB/IIIA receptor antagonists and evaluation of their molecular modeling.

Abciximab, Eptifibatide and Tirofiban are the three main glycoprotein IIb/IIIa receptor antagonists which have played a vital role in the field of cardiac medicine. They work by blocking the final mechanism of platelet aggregation pathway. These antagonists are widely used in treating acute coronary syndrome, myocardial infarction and during percutaneous coronary intervention (PCI). In this review, we have examined the chemistry, mechanism of action and clinical uses of these glycoprotein IIb/IIIa receptor antagonists. We also tried to study the binding mode of both eptifibatide and tirofiban with the glycoprotein IIb/IIIa receptors using molecular docking software. It appears that blocking the ASP 224 may be the cause for platelet activity inhibition.

Abciximab (ReoPro)-Induced Thrombocytopenia Diagnosed Through Measurement of Heparin-Dependent Antibody

Abciximab (ReoPro) is an extremely potent inhibitor of the glycoprotein IIb/IIIa receptor. Its main application is in the maintenance of coronary flow after suboptimal coronary intervention. Complications associated with this drug include bleeding and severe thrombocytopenia. We report a case of severe thrombocytopenia secondary to abciximab therapy for percutaneous coronary intervention in a 65-year-old woman suffering from an acute myocardial infarction. Her platelet count dropped to 1,000/mm3 7 hours after abciximab administration and improved with transfusion of 12 units of platelet concentrate the following day. The patient was diagnosed through measurement of heparin-dependent antibodies and readministration of heparin.

Hemorrhagic pericarditis with cardiac tamponade after percutaneous coronary intervention associated with the use of abciximab

Glycoprotein (GP) IIb/IIIa inhibitors, such as abciximab, are used as adjunctive therapy for percutaneous coronary intervention (PCI) in high-risk non-ST-elevation myocardial infarction (NSTEMI) and in ST-elevation myocardial infarction (STEMI), although their effects when used for STEMI are less clear. As the use of GP IIb/IIIa inhibitors becomes more widespread, determining the risks associated with them becomes more important. The major risks associated with the use of GP IIb/IIIa inhibitors are the potential for major bleeding and thrombocytopenia. This is the first reported case in Korea of hemorrhagic pericarditis resulting in cardiac tamponade associated with the use of abciximab, a commonly used GP Ilb/IIa inhibitor, following PCI.

A Case of Abciximab Induced Acute Profound Thrombocytopenia Resulting in Compartment Syndrome of the Forearm from Massive Bleeding at the Brachial Artery Access Site

Abciximab is one of the glycoprotein IIb/IIIa receptor inhibitors, and it is known to be effective for preventing and treating the thrombotic complications of percutaneous coronary intervention (PCI). On the other hand, there is an increasing risk of hemorrhagic complications when using abciximab, especially in the case of abciximab-induced thrombocytopenia. Acute profound thrombocytopenia is a rare, but life threatening adverse reaction to abciximab, and it can even occur within a few hours of the first exposure. We report here on a case of 56 year-old woman who experienced massive bleeding of her brachial artery access site. This was caused by abciximab-induced acute profound thrombocytopenia after performing PCI concomitant with using abciximab.

Efficacy of Femoral Vascular Closure Devices in Patients Treated with Anticoagulant, Abciximab or Thrombolytics during Percutaneous Endovascular Procedures

OBJECTIVE: This study assessed the outcomes of using vascular closure devices following percutaneous transfemoral endovascular procedures in the patients who were treated with heparin, abciximab or thrombolytics (urokinase or t-PA) during the procedures. MATERIALS AND METHODS: From March 28, 2003 to August 31, 2004, we conducted a prospective and randomized study in which 1,676 cases of 1,180 patients were treated with one of the two different closure devices (the collagen plug device was Angio-SealTM; the suture-mediated closure device was The Closer STM) at the femoral access site after instituting percutaneous endovascular procedures. Among the 1,676 cases, 108 cases (the drug group) were treated with heparin only (n = 94), thrombolytics only (n = 10), heparin and thrombolytics (n = 3), or abciximab and thrombolytics (n = 1) during the procedures; 1,568 cases (the no-drug group) were treated without any medication. We compared the efficacy and complications between the two groups. Of the drug group, 42 cases underwent arterial closures with the collagen plug devices and 66 cases underwent arterial closures with the suture-mediated closure devices. We also compared the efficacy and complications between these two groups. RESULTS: The immediate hemostasis rates were 92.9% (1,456/1,568) in the no-drug group and 91.7% (99/108) in the drug group. Early complications occurred in four cases of the drug group. These included two episodes of rebleeding with using the Closer S, which required manual compression for at least 10 minutes, and two episodes of minor oozing with using one Angio-Seal and one Closer S, which required two hours of additional bed rest. There was no late complication. So, the total success rates were 90.8% (1,423/1,568) in the no-drug group and 88.0% (95/108) in the drug group. These results were not significantly different between the two groups (p = 0.34). In the drug group, the difference of the successful hemostasis rate between the collagen plug devices and the suture-mediated devices was also not statistically significant (92.9% vs. 84.8%, respectively; p = 0.21). CONCLUSION: Arterial closure of the femoral access site with using vascular closure devices is both safe and effective, even in the patients who received heparin, abciximab or thrombolytics.

Effect of Intraarterially Administered Abciximab(Glycoprotein IIb-IIIa Inhibitor) in the Acute Cerebral Vascular Occlusion

OBJECTIVE: The authors report the safe recanalization after intraarterial injection of abciximab(glycoprotein IIb-IIIa inhibitor) in the acute cerebral vascular occlusion from the thromboembolism. METHODS: Eight patients with acute occlusion of cerebral arteries were treated by using an intraarterial infusion of urokinase and abciximab(Reopro(R)). Six patients had acute thromboembolic complication of endovascular therapy and two patients had acute basilar artery occlusion. Authors used mean 428, 000 units of the urokinase, and mean 6.2mg of the abciximab. In six cases, intraarterial urokinase and abciximab were infused shortly after the event of thrombosis duration endovascular procedure. RESULTS: In all cases, successful recanalization of thrombotic artery was achieved by using intraarterial abciximab and urokinase without bleeding complication. Seven patients recovered without neurologic deficit and one patient remained in locked-in neurological state. CONCLUSION: The authors believe that the intraarterial infusion of abxicimab even in small dose is effective and safe recanalization method in acute thrombotic occlusion of cerebral arteries, but further evaluation and study are needed.

A case of acute profound thrombocytopenia following abciximab therapy / 대한내과학회지

Bleeding and thrombocytopenia are important adverse effects of abciximab. The incidence of abciximab-induced acute profound thrombocytopenia (APT) is low. APT is defined as an abrupt drop in platelet count to <20,000/microL that occurred within 24 hours of administration of an abciximab. This is distinct from all other types of drug-induced thrombocytopenia, which requires a period of drug administration to induce sensitization. If APT occurs and is left untreated, it can cause serious hemorrhage and ischemia that may be fatal. In this case, a 45-year-old man with acute myocardial infarction was administered a bolus intravenous injection of abciximab (0.25 mg/kg), followed by a 12-hour continuous infusion (10 microgram/min) during primary coronary angioplasty. We report a case of APT that was recognized at 2 hours after the initiation of abciximab infusion and was corrected without serious complications.

Intracoronary thrombosis treated with stent and abciximab in patient with membranous glomerulonephritis

The association of nephrotic syndrome with a hypercoagulable state and vascular thrombosis is well recognized. In all adult series of nephrotics, venous thrombosis are much more common than arterial thrombosis, which has been mainly reported in children. Intracoronary thrombus is among the rarest arterial thromboses. We present a case of acute myocardial infarction in a 39-year-old women with nephrotic syndrome secondary to membranous glomeluronephritis, in which subsequent coronary angiography showed no evidence of atherosclerotic change and thrombotic occlusion in the left main coronary artery which was successfully treated with intracoronary stent and intravenous abciximab.

Rescue Utilization of Abciximab (ReoPro) for the Thrombus

The presence of pre-existing intracoronary thrombus has consistently been shown to be among the strongest predictors of unsuccessful angioplasty and abrupt vessel closure. Abciximab, platelet glycoprotein IIb/IIIa receptor antagonist, through prevention platelet aggregation and coronary thrombosis, has shown promise in helping to decrease the incidence of complications of PTCA when prophylatically administered in patients presenting with unstable angina or complex lesion morphology for PTCA and in lower risk patients as well. However, the cost of abciximab and its associated increased risk of bleeding may limit its use as a prophylactic treatment. This study was performed to evaluate the effect of the rescue administration of abciximab in seven patients with thrombus containing lesion during angioplasty. Thrombus was disappeared in 4 patients and decreased in 2 patients, and the follow-up angiogram showed normal brisk flow in all 6 patients. There were no death or myocardial infarction on clinical follow-up at a mean of 7 months except one which was developed restenosis at the angioplasty lesion. Dissolution of thrombus and restoration or maintenance of TIMI grade 3 flow were achieved without complications after administration of abciximab when delivered in a rescue manner on thrombus containing lesion during angioplasty. These results showed that failure to give preprocedural proph-ylactic abciximab did not appear to exclude the possibility of a beneficial effect of abciximab, given therapeutically during the early stage of thrombus formation in patients with complicated lesion during angioplasty.

Successful Coronary Interventions with the Aid of Abciximab (ReoPro (R)) in High-Risk Patients: Report of Two Cases / 대한구급학회지

Abrupt closure of coronary artery during coronary intervention is one of major limitations especially in high-risk patients. Platelets are responsible for composing acute thrombotic occlusion at the site of therapeutic arterial injury. Abciximab (platelet glycoprotein IIb/IIIa receptor blocker) might be helpful in preventing the acute thrombotic occlusion. We experienced an excellent effects of the drug in two cases of high-risk patients, unsuccessful thrombolytics and PTCA with acute occlusion. With additional use of abciximab we overcame the complications and succeeded in getting normal coronary flow and resultant successful angioplasties.