Abciximab

 Actions Binds to glycoprotein IIb/IIIa receptors on surface of platelets, thereby preventing platelet aggregation.

 Indications Adjunct to percutaneous coronary intervention (PCI) to prevent ischemic complications in patients at high risk of abrupt closure of the treated vessel. Intended for use with aspirin and heparin.

 Contraindications Active internal bleeding; recent (6 wk) GI/GU bleeding, major surgery, or trauma; history of CVA in the past 2 yr of CVA with significant residual neurological deficit; use of oral anticoagulants within 7 days unless prothrombin time < 1.2 times control; thrombocytopenia; severe uncontrolled hypertension; vasculitis; intracranial neoplasm, aneurysm, or arteriovenous malformation; or the recent or current use of IV dextran.

 Route/Dosage

ADULTS: IV 0.25 mg/kg bolus 10 to 60 min before PCI followed by continuous infusion at 10 g/min for 12 hr.

 Interactions None well documented.

 Lab Test Interferences None well documented.

 Adverse Reactions

CARDIOVASCULAR: Hypotension; bradycardia; atrial fibrillation; pulmonary edema; AV block; supraventricular tachycardia. CNS: Hypesthesia; headache; confusion; dizziness. EENT: Abnormal vision. GI: Nausea, vomiting. HEMATOLOGIC: Bleeding; thrombocytopenia; anemia; leukocytosis. RESPIRATORY: Pleural effusion; pneumonia. OTHER: Pain; peripheral edema.

 Precautions

Pregnancy: Category C. Lactation: Undetermined. Children: Safety and efficacy not established. Readministration: Abciximab may cause antibody development. Readministration may be associated with allergic reactions. Bleeding: Because risk of bleeding is increased, use cautiously, if at all, with thrombolytics, oral anticoagulants, NSAIDs, dipyridamole, and ticlopidine. Institute bleeding precautions. Thrombocytopenia: Monitor platelet counts.

 Administration/Storage

• Use only NS or D5 W for IV infusion. Add no other medication for the infusion.
• Do not use drug if vial contains visibly opaque particles.
• Withdraw medication through a 0.2 or 2.2 micron filter.
• Administer drug through a separate IV line with filter.
• Store vials at 2° to 8°C (36° to 46°F). Do not freeze. Do not shake. Discard any unused portion.

 Assessment/Interventions

• Obtain patient history.
• If symptoms of sensitivity occur any time during therapy, discontinue drug and initiate symptomatic and supportive therapy. Have epinephrine, dopamine, theophylline, antihistamines, and corticosteroids available.
• If serious bleeding occurs that is not controlled with pressure, stop infusion of abciximab and heparin.
• Avoid noncompressible sites when obtaining IV access.
• Discontinue heparin ³ 4 hr prior to removal of arterial sheath. Following removal, apply pressure for ³ 30 min, then apply a pressure dressing.
• Maintain the patient on bedrest for 6 to 8 hr.
• Frequently check insertion site and distal pulses while sheath is in place and 6 hr after removal. Measure any hematoma and monitor for enlargement.
• Avoid other invasive procedures during therapy.
• Prior to administration, check platelet count, PTT, and APTT. Monitor during and after treatment.

 Patient/Family Education

• Advise patient to report any bleeding or bruising to health care provider immediately.