[Use of abciximab during coronary angioplasty]

The IIb-IIIa glycoprotein is the platelet receptor of fibrinogen and the final common pathway of platelet activation and aggregation. Abciximab is a Fab fragment of the chimeric monoclonal antibody (c7E3) interfering with the glycoprotein receptor. It is the only anti IIb-IIIa currently available, commercialized under the name of Reopro. Preliminary clinical data has been obtained with its use in high risk coronary angioplasty. The EPIC trial showed a 35% relative reduction of the principal combined criterion of judgement of cardiac morbidity and mortality at 1 month, a benefit even greater in acute coronary syndromes (-72%) than in programmed procedures for complex type C lesions (-10%). The incidence of severe bleeding was high (14%). The results of the CAPTURE trial could widen the indications of abciximab to include the period surrounding angioplasty for unstable angina as the use of Reopro in the 24 hours before the procedure significantly reduced the risk of ischaemic events (10.8% versus 16.4%). In programmed angioplasty, the EPILOG trial investigated the effects of adapting the dose of heparin and an infusion of abciximab to body weight early (4th to 6th hour) withdrawal of the arterial introducer without continuing heparin. Using a 70 IU/Kg dosage modulated to algorithms taking into account the ACT, the incidence of bleeding complications was reduced to 1.8%, the same as the control group, and the benefits with regards to ischaemic events were not only maintained but increased (a 56% reduction at 1 months). Utilization of abciximab would be supported by the Cost saving approach of the EPIC trial 3-years follow-up which showed presentation of the initial benefits.