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"Rescue" utilization of abciximab for the dissolution of coronary thrombus developing as a complication of coronary
J B Muhlestein1, L A Karagounis, S Treehan
1Department of Medicine, University of Utah School of Medicine, LDS Hospital, Salt Lake City 84143, USA.
Insights
Rescue use of glycoprotein IIb/IIIa antagonist abciximab effectively dissolved intracoronary thrombus after percutaneous transluminal coronary angioplasty (PTCA). This treatment improved Thrombolysis in Myocardial Infarction (TIMI) flow, demonstrating clinical utility in managing post-PTCA complications.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pharmacology
Background:
- Abciximab is proven effective for preventing ischemic events during high-risk percutaneous transluminal coronary angioplasty (PTCA).
- The therapeutic efficacy of abciximab in dissolving pre-existing intracoronary thrombus post-PTCA remains largely unknown.
Purpose of the Study:
- To evaluate the impact of
- rescue
- abciximab administration on thrombus burden.
- To determine the clinical utility of abciximab in managing intracoronary thrombus complications following PTCA.
Main Methods:
- An observational study involving 29 patients who received abciximab post-PTCA for thrombus development or progression.
- Angiographic assessment of thrombus score and Thrombolysis in Myocardial Infarction (TIMI) flow grade before and after treatment.
- Evaluation of procedural and clinical success rates, along with long-term outcomes.
Main Results:
- Significant reduction in mean thrombus score (3.0 to 0.86, p < 0.001) and improvement in TIMI flow grade (2.5 to 2.9, p = 0.008).
- No instances of distal embolization or no-reflow phenomena were observed.
- High rates of procedural (97%) and clinical success (93%) were achieved.
Conclusions:
- Rescue
- abciximab administration effectively dissolves intracoronary thrombus and restores TIMI grade 3 flow after PTCA.
- This approach represents a novel therapeutic strategy for managing post-PTCA thrombosis.
- Further validation through randomized controlled trials is warranted.
Objectives:
This study sought to test the effect on thrombus score of the "rescue" utilization of the glycoprotein IIb/IIIa antagonist abciximab given to patients in whom intracoronary thrombus has developed as a complication after percutaneous transluminal coronary angioplasty (PTCA) and to determine its clinical utility.
Background:
Abciximab is effective in the prevention of acute ischemic complications when given prophylactically to patients during high risk PTCA. However, its ability to therapeutically dissolve newly formed intracoronary thrombus occurring as a complication after PTCA is not known.
Methods:
We performed an observational study in 29 consecutive patients who received abciximab (0.25 mg/kg body weight intravenous bolus, followed by a 12-h infusion at 10 microg/min) after attempted PTCA caused either the new development or further progression of thrombus. Angiograms were analyzed to determine thrombus score and Thrombolysis in Myocardial Infarction (TIMI) flow grade before and after abciximab. Procedural and clinical success and long-term outcome were also determined.
Results:
Thrombus score decreased from 3.0 +/- 0.9 (mean +/- SD) to 0.86 +/- 0.92 (p < 0.001), and TIMI flow grade increased from 2.5 +/- 0.7 to 2.9 +/- 0.3 (p = 0.008). No instances of distal embolization or no-reflow were noted. The procedural success (< or = 50% residual stenosis) rate was 97%. The clinical success (procedural success with no in-hospital myocardial infarction, bypass surgery or death) rate was 93%.
Conclusions:
Dissolution of thrombus and restoration of TIMI grade 3 flow were readily achieved after administration of abciximab when delivered in a "rescue" manner after the development of thrombosis after PTCA. This novel use of abciximab will need to be validated in randomized trials.