The Platelet IIb/IIIa Inhibitor Abciximab as Adjunctive Therapy in Carotid Stenting of Potential Thrombotic Lesions

Ceceña, Felipe A.; Hoelzinger, David H.; Miller, J; Abu-Shakra, Sawsan

doi:10.1111/j.1540-8183.1999.tb00259.x

Cited by 16 publications

(4 citation statements)

References 17 publications

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“…When given alone or in combination with heparin it was shown to improve recovery of the treated patients [49]. Abciximab was used in endovascular procedures and was found effective to prevent ischemic stroke and to be safe [50]. Specifically, abciximab was used in 29 of more than 1300 patients who had become symptomatic during the neuroendovascular procedure.…”

Section: Abciximabmentioning

confidence: 98%

Platelet GPIIb/IIIa Receptor Antagonists in Human Ischemic Brain Disease

Seitz¹,

Siebler

2008

CVP

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The goal of acute stroke therapy is to salvage brain tissue by rapid cerebral artery recanalization to improve microcirculation. A major drawback of fibrinolysis is the activation of platelets leading to a high rate of re-occlusion. Antagonists of the platelet GPIIb/IIIa-receptor inhibit the binding of fibrinogen to platelets counteracting secondary thrombus formation. Also, they were shown to suppress thrombembolus formation and to limit lesion development in cerebral ischemia. We review the literature concerning the use of intravenously administered GPIIb/IIIa-receptor antagonists abciximab, eptifibatide and tirofiban for the treatment of patients with acute ischemic brain infarction. In multicenter, prospective, randomized and placebo-controlled trials abciximab had a higher cerebral bleeding risk, while tirofiban did not increase hemorrhage. When combined with fibrinolysis, abciximab and tirofiban were found to improve cerebral artery recanalization and tissue reperfusion resulting in reduced infarct volumes and improved neurological outcome. Thus, GPIIb/IIIa-receptor antagonists have a great potential for the treatment of acute stroke.

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Section: Abciximabmentioning

confidence: 98%

Platelet GPIIb/IIIa Receptor Antagonists in Human Ischemic Brain Disease

Seitz¹,

Siebler

2008

CVP

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“…Percutaneous cerebrovascular interventions. There have been anecdotal reports of beneficial effects of abciximab treatment as adjunctive therapy of cerebrovascular angioplasty and stent placement, as well as intraarterial basilar artery thrombolysis (124)(125)(126)(127)(128).…”

Section: Indications Currently Under Investigationmentioning

confidence: 99%

Anti-GPIIb/IIIa Drugs: Current Strategies and Future Directions

2001

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SummaryThree platelet glycoprotein (GP) IIb/IIIa receptor antagonists have been approved as adjunctive therapy to decrease the ischemic complications of percutaneous coronary interventions (PCI) and/or unstable angina. They include the chimeric murine/human monoclonal antibody 7E3 Fab fragment (abciximab), a cyclic heptapeptide based on the KGD amino acid sequence (eptifibatide), and a nonpeptide mimetic of the RGD sequence (tirofiban). The agents are very effective in providing both short-term and long-term benefit after PCI, and one agent has also demonstrated a progressive long-term mortality benefit. The long-term mortality benefit is highly cost-effective when compared to other medical interventions. The benefits in treating unstable angina without PCI are less dramatic and robust, with some agents providing no benefit. Severe thrombocytopenia is an infrequent, but potentially serious, complication of therapy with all of the agents. The risk of major bleeding is increased only minimally or not at all by the drugs. Currently, a number of new indications for GPIIb/IIIa antagonists are under study, including acute myocardial infarction (± thrombolytic therapy, ± PCI) and stroke. In addition to their impact on improving outcome, the results of clinical trials with these agents provide crucial insights into the contribution of GPIIb/IIIa-mediated platelet function in the pathophysiology of thrombotic vascular disease.

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“…[15][16][17] In humans the GPIIb/ IIIa platelet receptor antagonist abciximab has been shown to dissolve intravascular thrombi 18,19 and to improve neurological outcome after stroke and carotid artery stenting. 20,21 Notably, the use of GPIIb/IIIa receptor antagonists in ischemic cerebrovascular disease and manifest brain infarction does not seem to be associated with a high rate of fatal or symptomatic intracranial hemorrhage. 22,23 In particular, the combination of half the dosage of thrombolytic agents together with the GPIIb/IIIa receptor antagonists has been reported to be effective in terms of reperfusion and safe in terms of bleeding complications in acute myocardial ischemia.…”

mentioning

confidence: 99%

Thrombolysis With Recombinant Tissue Plasminogen Activator and Tirofiban in Stroke

Seitz

Hamzavi

Junghans

et al. 2003

Stroke

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Background and Purpose-We sought to investigate the feasibility of the combined use of low-dose recombinant tissue plasminogen activator (rtPA) and tirofiban, a glycoprotein IIb/IIIa (GPIIb/IIIa) receptor antagonist, for systemic thrombolysis in acute stroke. Methods-Consecutive patients who were treated with systemic application of low-dose rtPA and body weight-adjusted tirofiban (rtPAϩT group; nϭ37) were evaluated retrospectively during 1999 -2001. Patients in the rtPAϩT group were compared with a group of patients treated with a dose of 0.9 mg/kg body weight in a different center (rtPA group; nϭ119). The 41 patients with infarctions of the middle cerebral artery territory who were not eligible for thrombolytic treatment because of medical contraindications or arrival in the hospital Ͼ3 hours after stroke onset served as controls. For matched comparisons, the National Institutes of Health Stroke Scale on admission and the Rankin Scale on discharge 5 days after stroke were used. Results-The patients treated with rtPAϩT or rtPA improved (PϽ0.05) compared with the controls at discharge; patients in the rtPAϩT and rtPA groups reached a Rankin Scale score of 0 to 2 in 63% and 55%, respectively, while only 16% of the controls achieved this score. Death rates (8% in rtPAϩT group and 5% in rtPA group) were similar among the 2 treatment groups. They included 1 fatal hemorrhage in the rtPAϩT group and 4 fatal hemorrhages in the rtPA group. Five percent of the untreated patients developed symptomatic, nonfatal cerebral hemorrhage. Conclusions-Systemic combined thrombolysis with rtPAϩT seems to be a feasible treatment in acute stroke.

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The Platelet IIb/IIIa Inhibitor Abciximab as Adjunctive Therapy in Carotid Stenting of Potential Thrombotic Lesions

Cited by 16 publications

References 17 publications

Platelet GPIIb/IIIa Receptor Antagonists in Human Ischemic Brain Disease

Platelet GPIIb/IIIa Receptor Antagonists in Human Ischemic Brain Disease

Anti-GPIIb/IIIa Drugs: Current Strategies and Future Directions

Thrombolysis With Recombinant Tissue Plasminogen Activator and Tirofiban in Stroke

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