π Antiplatelet Glycoprotein
Interferes with platelet membrane function by inhibiting fibrinogen binding and platelet platelet
Interactions
; inhibits platelet aggregation and prolongs bleeding time; effect is irreversible for life of the platelet. Indications
Adjunct to percutaneous coronary intervention (PCI) for the prevention of cardiac ischemic complications in patients undergoing PCI and with unstable angina not responding to conventional therapy when PCI is planned within 24 hr; intended to be used with heparin and aspirin therapy Unlabeled uses: Early treatment of acute MI or acute ischemic stroke Contraindications and cautions
Contraindicated with allergy to abciximab; neutropenia; thrombocytopenia (fewer than 100,000 cells/mcL); hemostatic disorders; bleeding ulcer; intracranial bleeding; major trauma; vasculitis; recent major surgery; aneurysm; use of IV dextran (before or during PCI); pregnancy; severe, uncontrolled hypertension; active internal bleeding; recent (within 6 wk) GI or GU bleeding; history of stroke within 2 yr; administration of oral anticoagulants within 7 days (unless PT is 1.2 times control or less). Use cautiously during lactation and with concurrent use of anticoagulants, thrombolytics, or antiplatelet drugs. Available forms Injection2 mg/mL Dosages Efficacy of abciximab has only been studied in combination with heparin and aspirin. Adults Adjunct to PCI: 0.25 mg/kg by IV bolus 1060 min prior to procedure, followed by continuous infusion of 0.125 mcg/kg/min (maximum dose 10mcg/min) for 12 hr. Unstable angina not responding to conventional medical therapy when PCI is planned within 24 hr: 0.25 mg/kg by IV bolus over at least 1 min; then 10mcg/min by IV infusion for 1824 hr, concluding 1 hr after PCI. Pediatric patients Safety and efficacy not established. Pharmacokinetics Route Onset Peak IV Rapid 30 min Metabolism: Cellular; T1/2: less than 10min, then 30 min Distribution: Crosses placenta; may enter breast milk Excretion: Unknown ?IV FACTS Preparation: Withdraw the necessary amount through a 0.2- or 0.5-micron filter for bolus injection. Prepare infusion by withdrawing necessary amount through filter into syringe; inject into 250 mL 0.9% sterile saline or 5% dextrose; an 0.2- or 0.22-micron filter should be used for continuous infusion. Do not use any solution that contains visibly opaque particles; discard solution after 12 hr. Do not shake; refrigerate solution. Infusion (as adjunct to PCI): 1060 min before procedure give bolus of 0.25 mg/kg over at least 1 min; give continuous infusion at rate of 0.125 mcg/kg/min (to a maximum dose of 10 mcg/min) for 12 hr. Incompatibilities: Do not mix in solution with any other medication; give through a separate IV line. Adverse effects
CNS: Dizziness, confusion, anxiety CV: Bradycardia, hypotension,arrhythmias, edema GI: Nausea, vomiting Hematologic: Thrombocytopenia, bleeding Local: Pain, edema Respiratory: Pneumonia, pleural effusion Interactions
Drug-drug Risk of increased bleeding if combined with anticoagulants, antiplatelets, or thrombolytics; monitor patient accordingly. Nursing considerations
Assessment
History: Allergy to abciximab, neutropenia, thrombocytopenia, hemostatic disorders, bleeding ulcer, intracranial bleeding, severe liver disease, lactation, renal disorders, pregnancy, recent trauma or surgery Physical: Skin color, lesions; orientation; bowel sounds, normal output; CBC, LFTs, renal function tests Interventions
Monitor CBC count before use and frequently while initiating therapy. Monitor patient for signs and symptoms of bleeding. Arrange for concomitant aspirin and heparin therapy. Establish safety precautions to prevent injury and bleeding (such as using electric razor, not playing contact sports). Provide increased precautions against bleeding during invasive proceduresbleeding will be prolonged. Mark chart of any patient receiving abciximab to alert medical personnel to potential for increased bleeding in surgery or dental surgery. Teaching points
It may take longer than normal to stop bleeding while on this drug; avoid playing contact sports, use electrical razors, and take other precautions. Apply pressure for extended periods to bleeding sites. You may experience these side effects: Upset stomach, nausea. Report fever, chills, sore throat, rash, bruising, bleeding, dark stools or urine.
