Abciximab
ReoPro
Glycoprotein IIb/IIIa receptor inhibitor (monoclonal antibody)
Fab fragment that irreversibly blocks the platelet GP IIb/IIIa receptor → prevents fibrinogen cross-linking (final common pathway of aggregation).
Indications
- •PCI (adjunct)
- •ACS
Dosing
| Context | Adult | Pediatric |
|---|---|---|
| PCI | 0.25 mg/kg IV bolus, then 0.125 mcg/kg/min (max 10 mcg/min) × 12 h | — |
Pharmacokinetics
Onset minutes. Platelet-bound effect long (receptor blockade 24–48 h) despite short plasma half-life.
Side effects
- !Bleeding
- !Thrombocytopenia (can be profound/acute)
- !Hypotension
Contraindications
- ×Active bleeding
- ×Recent stroke
- ×Thrombocytopenia
Clinical pearls
- ★ASRA neuraxial: platelet function recovers ~24–48 h — time neuraxial accordingly.
- ★Platelet transfusion works for abciximab bleeding (antibody redistributes) — unlike the small-molecule GP IIb/IIIa agents.
- ★Check platelets early — acute profound thrombocytopenia is a known reaction.
Other drugs in Antiplatelets
- Aspirin
Irreversibly acetylates COX-1 → blocks thromboxane A2 for the platelet's lifespan (~7–10 days). Antiplatelet effect at low dose; analgesic/anti-inflammatory at high dose.
- Clopidogrel
Prodrug → active metabolite (CYP2C19) irreversibly blocks the platelet P2Y12 ADP receptor for the platelet lifespan.
- Prasugrel
Prodrug → active metabolite irreversibly blocks P2Y12. More potent + more consistent than clopidogrel (not CYP2C19-limited), but more bleeding.
- Ticagrelor
Directly and REVERSIBLY inhibits P2Y12 (not a prodrug, not thienopyridine). Faster onset/offset than clopidogrel.
- Ticlopidine
Irreversibly blocks P2Y12. Largely replaced by clopidogrel due to hematologic toxicity.
- Eptifibatide
Reversibly blocks GP IIb/IIIa (final common pathway of platelet aggregation). Short-acting.
- Dipyridamole
Inhibits platelet PDE (↑ cAMP) and adenosine reuptake (↑ adenosine → vasodilation). Weak antiplatelet; also a coronary vasodilator used in stress testing.
Suggested reading
- •Miller's Anesthesia, 9e
- •FDA package insert
- •ASRA regional anesthesia in the anticoagulated patient guidelines, 2018
