An integrated structural pharmacokinetic/pharmacodynamic (PK/PD) model was developed for the glycoprotein IIb/IIIa antagonist abciximab administered to patients undergoing percutaneous transluminal coronary angioplasty. PK/PD data, in the form of plasma abciximab concentrations and ex vivo platelet aggregation in the presence of 20 M adenosine diphosphate, were obtained from two previously conducted clinical studies. Study 1 consisted of patients who were given abciximab as a single intravenous injection of 0.25 mg/kg (n ϭ 32). Patients in study 2 received an identical bolus dose, followed by a 36-h infusion at 0.125 g/kg/min (n ϭ 15). The PK component of the final model included drug-receptor binding, nonspecific distribution, and linear systemic clearance, whereas the PD module assumed that ex vivo dynamics were controlled by free plasma drug concentration. Mean PK/PD data from both studies were fitted simultaneously using nonlinear regression. PK profiles from both studies show rapidly decreasing plasma abciximab concentrations at early time points, but with extended terminal disposition phases. The maximum effect (E max ϭ 83.6%) was achieved rapidly and gradually returned to baseline values, although inhibition could be measured long after abciximab concentrations dropped below the detection limit. The final model well described the resulting PK/PD profiles and allowed for parameter estimation with relatively small coefficients of variation. Simulations were conducted to assess predicted receptor-occupancy and effects of selected parameters on PK/PD profiles. Models such as the one developed in this study demonstrate how drug binding to pharmacological targets may influence the PK of certain drugs and also provide a suitable paradigm for defining the PK/PD relationships of similar compounds.Activation of the glycoprotein (GP) IIb/IIIa platelet-surface integrin by endogenous agonists (e.g., thrombin, adenosine diphosphate or ADP, and collagen) results in the binding of adhesive proteins such as fibrinogen and von Willebrand factor, thus mediating platelet aggregation (Phillips et al., 1991). Antagonists directed against this receptor represent a family of antiplatelet drugs that are used clinically for the prevention of pathological thromboses (Majerus and Tollefsen, 2001). Abciximab, a monoclonal antibody Fab fragment, was the first approved agent in this class of drugs (Coller, 1997) and has been shown to prevent acute cardiac ischemic complications from percutaneous transluminal coronary angioplasty (PTCA) and atherectomy (EPIC Investigators, 1994). Typical dosing regimens include a weight-normalized i.v. bolus dose of 0.25 mg/kg, followed by an i.v. infusion of 0.125 g/kg/min (up to a maximum of 10 g/min) for 12 to 24 h, depending on the indication. This scheme was designed to achieve and sustain greater than 80% receptor occupancy and less than 20% of baseline ex vivo platelet aggregation (induced by 20 M ADP), which was shown to correspond with the prevention of in vivo thrombus formation in mo...