None reported

Bleeding, thrombocytopenia, development of human anti-chimeric antibody (HACA),

diarrhea, constipation,

hemolytic anemia, petechiae,

abnormal thinking, dizziness,

coma, brain ischemia, insomnia

Because abciximab increases risks of bleeding, it is contraindicated in- active internal bleeding, GI or GU bleeding of clinical significance, major surgery or trauma, intracranial neoplasm, severe uncontrolled hypertension.

Special precautions:

Monitoring before infusion of abciximab, measure platelet count, use caution when it is used with other drugs that affect hemostatis.

Thrombocytopenia- monitor platelet count prior to treatment

Approved by FDA on December 22, 1994

Indications:

Platelet aggregation inhibition

Dosage:

Abciximab is intended for use in patients undergoing PTCA. The safety and efficacy of abciximab have only been investigated with concomittant administration of heparin and aspirin.

Recommended dose- IV bolus of 0.25mg/kg administered 10 to 60 minutes before the start PTCA followed by a continous IV infusion of 10mcg/min for 12 hours

Missed dose :

1. If you miss a dose of this medicine, and remember within 6 hours of take it as soon as possible unless the dose is less than 4 hours.

2. However, if you do not remember until later, skip the missed dose and go back to your regular dosing schedule.

3. Do not double doses.

                         EVIDENCE BASED MEDICINE (MIMS April 2003)

Stroke prevention Comparative effectiveness of various interventions

PRIOR TO STROKE OR TRANSIENT ISCHAEMIC ACCIDENT (TIA)

Beneficial

1. Antiplatelet treatment

2. Cholestrerol reduction (for those patients who also have coronary heart disease)

3. Carotid endarterectomy (in patients with severe symptomatic carotid artery stenosis)

Unknown effectiveness

1. Cholesterol reduction (for patients without CHD)

2. Blood pressure reduction

3. Carotid endarterectomy (in patients with severe symptomatic carotid artery stenosis)

4. Catotid angioplasty Likely to ineffective or even harmful

Oral anticoagulation ATRIAL FIBRILLATION AND A PRIOR STROKE OR TIA Beneficial 1. Oral anticoagulation

2. Aspirin for patients with contraindications to an anticoagulant

ATRIAL FIBRILLATION BUT NO OTHER MAJOR RISK FACTORS FOR STROKE

Likely to be beneficial.

KEY POINTS

In patients with a prior stroke or TIA

1. Insufficient evidence to support routine blood presure reduction

2. Statins may prevent stroke in those with a history of CHD but evidence inconclusive in those with no history of CHD.

3. Routine use of prolonged anti-platelet treatment beneficial ( if no contraindication)

4. Aspirin 75mg daily as effective as higher doses. No evidence that any other antiplatelet regimen is definitely superior in the prevention of vascular events. Clopidogrel or the combination of asprin and dipyridamole are safe and effective (but more costly) alternatives to aspirin

5. No evidence of benefit from anti-coagulation in patients in sinus rhythm, but an increased risk of serious bleeding

6. Carotid endarterectomy reduces risk of major stroke in patients with severe carotid stenosis provided the risks of imaging and surgery are small.

7. Percutaneous transluminal angioplastys role has not been evaluated adequately In patients with atrial fibrillation and a pror stroke or TIA

• Anticoagulants reduce risk of stroke, provided there is low risk of bleeding and careful monitoring
•  Aspirin reduces risk of stroke but less effectively than anticoagulants. These findings support the use of aspirin among patients with atrial fibrillation and contra-indication to anticoagulants In patients with atrial fibrillation but neither major risk factors for stroke
• Anticoagulants are of net benefit, if low risk of bleeding and careful monitoring
•  Aspirin is a reasonable alternative in patients with contra-indications to anticoagulants

Pharmacology:

Abciximab is the Fab fragment of the chimeric human-murine monoclonal antibody 7ES. The drug inhibits platelet aggregation by preventing the binding of fibinogen von Willbrand factor and other adhesive molecules to receptor sites on activated platelets

Pharmacokinetics:

Following IV bolus admin, free plasma concentrations of abciximab decreases rapidly with an initial half-life of less than 10 minutes and a second phase half-life of about 30 minutes.

Pregnancy:

Give to a pregnant woman only if clearly needed.

Lactation:

Excercise caution when abciximab is administered to a nursing woman.