BLACK BOX WARNING
- serious bleeding events; increased risk of intracranial hemorrhage
abciximab
Brand: ReoPro
⚠ BBW ISMP High Alert Prototype Drug
Drug Class: glycoprotein IIb/IIIa inhibitor
Drug Family: antiplatelet
Subclass: chimeric monoclonal antibody fragment (Fab)
Organ Systems: cardiovascularhematology-oncology
Mechanism of Action
Chimeric human-murine Fab fragment that binds to glycoprotein IIb/IIIa receptors on platelets with high affinity, preventing fibrinogen and von Willebrand factor binding, thereby blocking the final common pathway of platelet aggregation regardless of the triggering stimulus.
glycoprotein IIb/IIIa receptor (integrin alphaIIb-beta3)
Indications
- adjunct to PCI in high-risk coronary interventions
- unstable angina not responding to conventional therapy when PCI planned within 24 hours
Contraindications
- active internal bleeding
- recent (within 6 weeks) significant GI or genitourinary bleeding
- recent stroke (within 2 years)
- major surgery within 6 weeks
- history of vasculitis
- thrombocytopenia <100,000 cells/mcL
- severe uncontrolled hypertension
- oral anticoagulants within 7 days unless PT <1.2x control
Adverse Effects
Common
- bleeding (access site, GI, genitourinary)
- thrombocytopenia
- hypotension
- nausea
Serious
- major hemorrhage
- severe acute thrombocytopenia
- intracranial hemorrhage
- HACA formation (human anti-chimeric antibodies)
Pharmacokinetics (ADME)
| Absorption | IV administration only |
| Distribution | rapidly binds to GP IIb/IIIa receptors; free plasma levels low |
| Metabolism | proteolytic degradation; not CYP-dependent |
| Excretion | clearance via receptor-mediated endocytosis and reticuloendothelial system |
| Half-life | initial ~10 minutes (plasma); platelet-bound half-life 12-24 hours (platelet-bound drug persists) |
| Onset | immediate (within minutes of bolus) |
| Peak | end of bolus |
| Duration | platelet function recovery 24-48 hours after discontinuation |
| Protein Binding | N/A (receptor-bound) |
| Vd | rapidly distributes to platelet receptor pool |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| heparin (concurrent use) | combined antiplatelet/anticoagulant effect substantially increases bleeding risk; heparin dose reduction required during PCI | major |
| thrombolytics | additive hemorrhagic risk; generally contraindicated in combination | major |
| other GP IIb/IIIa inhibitors | additive receptor blockade increases thrombocytopenia and bleeding risk | major |
Nursing Considerations
- Monitor platelet count 2-4 hours after bolus and again at 24 hours; abciximab causes acute profound thrombocytopenia in 1-2% of patients — if platelets fall below 100,000, notify physician and prepare for potential drug discontinuation.
- Minimize femoral access site trauma; apply direct pressure for 30 minutes after sheath removal; patient should remain supine with head elevated no more than 30 degrees for at least 6 hours post-PCI.
- Monitor all access sites, urine, stool, and nasogastric aspirate for blood; document IV line sites and avoid unnecessary arterial punctures during and for 12 hours post-infusion.
- Keep aPTT between 60-85 seconds during heparin co-administration; verify reduced heparin protocol per institutional PCI orders when abciximab is used concurrently.
Clinical Pearls
- Abciximab's irreversible binding to GP IIb/IIIa means platelet function does not recover until enough new platelets are generated — approximately 24-48 hours; platelet transfusion can restore function in cases of life-threatening bleeding.
- The chimeric structure of abciximab (part murine) can elicit human anti-chimeric antibodies (HACA), making re-administration potentially less effective and potentially more immunogenic than with the small-molecule GP IIb/IIIa inhibitors.
Safety Profile
Pregnancy use-with-caution
Lactation insufficient-data
Renal Adjustment Not required
Hepatic Adjustment Not required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.