This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Tcheng, J. E. Articles by Braden, G. A. Search for Related Content PubMed PubMed Citation Articles by Tcheng, J. E. Articles by Braden, G. A. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB ACETYLSALICYLIC ACID HEPARIN Medline Plus Health Information Angioplasty Platelet Disorders Related Collections Cardiovascular Pharmacology Platelet function inhibitors Catheter-based coronary and valvular interventions: other Catheter-based coronary interventions: stents

(Circulation. 2001;104:870.)
© 2001 American Heart Association, Inc.

Clinical Investigation and Reports

Abciximab Readministration

Results of the ReoPro Readministration Registry

James E. Tcheng, MD; Dean J. Kereiakes, MD; A. Michael Lincoff, MD; Barry S. George, MD; Neal S. Kleiman, MD; David C. Sane, MD; Douglas B. Cines, MD; Robert E. Jordan, PhD; Mary Ann Mascelli, PhD; Mary Ann Langrall, BS, MT; Lakshmi Damaraju, PhD; Allen Schantz, MS; Mark B. Effron, MD; Gregory A. Braden, MD; , for the ReoPro Readministration Registry Investigators

From The Duke Clinical Research Institute, Durham, NC (J.E.T.); the Carl and Edyth Lindner Center for Clinical Cardiovascular Research and Ohio Heart Health Center, Cincinnati, Ohio (D.J.K.); the Cleveland Clinic Foundation, Cleveland, Ohio (A.M.L.); the Midwest Cardiology Research Foundation, Columbus, Ohio (B.S.G.); Baylor College of Medicine and the Methodist Hospital, Houston, Tex (N.S.K.); Wake Forest University School of Medicine, Winston-Salem, NC (D.C.S., G.A.B.); University of Pennsylvania, Philadelphia, Pa (D.B.C.); Centocor, Malvern, Pa (R.E.J., M.A.M., M.A.L., L.D., A.S.); and Lilly Research Laboratories, Indianapolis, Ind (M.B.E.).

Correspondence to James E. Tcheng, MD, Box 3275, Duke University Medical Center, Durham, NC 27710. E-mail tchen001{at}mc.duke.edu

Background—— Platelet glycoprotein IIb/IIIa blockade with abciximab (ReoPro) improves the clinical outcomes of percutaneous coronary intervention. This registry was conducted to characterize the effects of repeated administration of abciximab during intervention.

Methods and Results—— We recruited 500 consecutive patients at 22 centers in the United States who were receiving abciximab for at least a second time during percutaneous coronary intervention. Safety was measured as the incidence of hypersensitivity reactions, major bleeding, and thrombocytopenia. Efficacy was assessed as event-free clinical success. Human antichimeric antibody (HACA) responses were also characterized. There were no cases of hypersensitivity (95% upper confidence bound, 0.3%), major bleeding, or death. Clinical success was 94.4%. Thrombocytopenia occurred in 23 patients (4.6%; 95% CI, 2.8% to 6.4%), including 12 (2.4%; 95% CI, 1.1% to 3.7%) who developed profound thrombocytopenia (<20x10⁹ cells/L). In 2 patients (0.4%), profound thrombocytopenia did not develop until after hospital discharge; in 4 (0.8%), profound thrombocytopenia recurred despite platelet transfusion. Before a first readministration, a positive HACA titer was present in 22 of 454 patients (4.8%); after a first readministration, an additional 82 of 432 (19.0%) became HACA-positive. HACA did not neutralize the in vitro inhibition of platelet aggregation by abciximab or correlate with clinical events.

Conclusions—— The results, including overall rates of thrombocytopenia, were consistent with randomized clinical trials of first abciximab treatment. However, there was a shift from mild to profound thrombocytopenia, and cases of delayed presentation and of recurrent thrombocytopenia were seen. These findings suggest that indications and guidelines for first-time use apply to retreatment, particularly the systematic monitoring for thrombocytopenia.

Key Words: angioplasty • platelet aggregation inhibitors • pharmacodynamics • thrombocytopenia

This article has been cited by other articles:

				A. Greinacher, B. Fuerll, H. Zinke, B. Mullejans, W. Kruger, N. Michetti, W. Motz, and H. Schwertz Megakaryocyte impairment by eptifibatide-induced antibodies causes prolonged thrombocytopenia Blood, August 6, 2009; 114(6): 1250 - 1253. [Abstract] [Full Text] [PDF]

				C. Patrono, C. Baigent, J. Hirsh, and G. Roth Antiplatelet Drugs: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 199S - 233S. [Abstract] [Full Text] [PDF]

				R. H. Aster and D. W. Bougie Drug-Induced Immune Thrombocytopenia N. Engl. J. Med., August 9, 2007; 357(6): 580 - 587. [Full Text] [PDF]

				The Society of Thoracic Surgeons Blood Conservatio, V. A. Ferraris, S. P. Ferraris, S. P. Saha, E. A. Hessel II, C. K. Haan, B. D. Royston, C. R. Bridges, R. S.D. Higgins, G. Despotis, et al. Perioperative Blood Transfusion and Blood Conservation in Cardiac Surgery: The Society of Thoracic Surgeons and The Society of Cardiovascular Anesthesiologists Clinical Practice Guideline Ann. Thorac. Surg., May 1, 2007; 83(5_Supplement): S27 - S86. [Abstract] [Full Text] [PDF]

				W. H. Matthai Jr Thrombocytopenia in Cardiovascular Patients: Diagnosis and Management Chest, February 1, 2005; 127(2_suppl): 46S - 52S. [Abstract] [Full Text] [PDF]

				R. H. Aster Immune Thrombocytopenia Caused by Glycoprotein IIb/IIIa Inhibitors Chest, February 1, 2005; 127(2_suppl): 53S - 59S. [Abstract] [Full Text] [PDF]

				J. C Coons, R. A Barcelona, T. Freedy, and M. F Hagerty Eptifibatide-Associated Acute, Profound Thrombocytopenia Ann. Pharmacother., February 1, 2005; 39(2): 368 - 372. [Abstract] [Full Text] [PDF]

				C. Patrono, B. Coller, G. A. FitzGerald, J. Hirsh, and G. Roth Platelet-Active Drugs: The Relationships Among Dose, Effectiveness, and Side Effects: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 234S - 264S. [Abstract] [Full Text] [PDF]

				P. A. Merlini, M. Rossi, A. Menozzi, S. Buratti, D. M. Brennan, D. J. Moliterno, E. J. Topol, and D. Ardissino Thrombocytopenia Caused by Abciximab or Tirofiban and Its Association With Clinical Outcome in Patients Undergoing Coronary Stenting Circulation, May 11, 2004; 109(18): 2203 - 2206. [Abstract] [Full Text] [PDF]

				M. A Crouch, J. M Nappi, and K. I Cheang Glycoprotein IIb/IIIa Receptor Inhibitors in Percutaneous Coronary Intervention and Acute Coronary Syndrome Ann. Pharmacother., June 1, 2003; 37(6): 860 - 875. [Abstract] [Full Text] [PDF]

				D. Seiffert, A. M. Stern, W. Ebling, R. J. Rossi, Y. C. Barrett, R. Wynn, G. F. Hollis, B. He, C. J. Kieras, D. L. Pedicord, et al. Prospective testing for drug-dependent antibodies reduces the incidence of thrombocytopenia observed with the small molecule glycoprotein IIb/IIIa antagonist roxifiban: implications for the etiology of thrombocytopenia Blood, January 1, 2003; 101(1): 58 - 63. [Abstract] [Full Text] [PDF]

				R. Chun, B. A. Orser, and M. Madan Platelet Glycoprotein IIb/IIIa Inhibitors: Overview and Implications for the Anesthesiologist Anesth. Analg., October 1, 2002; 95(4): 879 - 888. [Full Text] [PDF]

				J. T. Billheimer, I. B. Dicker, R. Wynn, J. D. Bradley, D. A. Cromley, H. E. Godonis, L. C. Grimminger, B. He, C. J. Kieras, D. L. Pedicord, et al. Evidence that thrombocytopenia observed in humans treated with orally bioavailable glycoprotein IIb/IIIa antagonists is immune mediated Blood, May 15, 2002; 99(10): 3540 - 3546. [Abstract] [Full Text] [PDF]

				S. Sharma, B. Bhambi, W. Nyitray, G. Sharma, S. Shambaugh, A. Antonescu, P. Shukla, and E. Denny Delayed Profound Thrombocytopenia Presenting 7 Days After Use of Abciximab (ReoPro) Journal of Cardiovascular Pharmacology and Therapeutics, March 1, 2002; 7(1): 21 - 24. [Abstract] [PDF]

				Abciximab Readministration Causes More Thrombocytopenia Journal Watch Cardiology, October 26, 2001; 2001(1026): 5 - 5. [Full Text]