(Circulation. 1999;100:1977-1982.)
© 1999 American Heart Association, Inc.
Clinical Investigation and Reports |
Attainment and Maintenance of Platelet Inhibition Through Standard Dosing of Abciximab in Diabetic and Nondiabetic Patients Undergoing Percutaneous Coronary Intervention
From the Department of Cardiology, Wilford Hall Medical Center (S.R.S.); Department of Cardiology and Joseph J. Jacobs Center for Thrombosis and Vascular Biology (D.J.M., M.L.R., E.J.T., A.M.L.); Department of Clinical Pathology (K.K.M.); and Department of Biostatistics and Epidemiology (N.K.G.), Cleveland Clinic Foundation, Cleveland, Ohio; and the Division of Hematology (B.S.C.), Department of Medicine, Mount Sinai School of Medicine, New York, NY.
Correspondence to Steven R. Steinhubl, MD, Wilford Hall Medical Center, Department of Cardiology, 2200 Bergquist Dr, Lackland AFB, TX 78236. E-mail steinhubl{at}sprintmail.com
Background—Although the effectiveness of abciximab (c7E3 Fab; ReoPro) in large populations of patients undergoing a percutaneous coronary intervention has been consistently proved in clinical trials, it is unknown whether all patients achieve and maintain target inhibition during treatment. Diabetic patients in particular are a subgroup of patients with known underlying platelet abnormalities whose long-term response to abciximab has been shown to vary from that of nondiabetic patients.
Methods and Results—Forty-nine diabetic and 51 nondiabetic patients who received adjunctive abciximab therapy during percutaneous coronary interventions were evaluated prospectively. The degree of platelet function inhibition was determined immediately after the abciximab bolus, 8 hours after the bolus (during the 12-hour abciximab infusion), and the next morning (13 to 26 hours after the bolus) with the use of a rapid platelet function assay (Accumetrics). After the abciximab bolus, platelet function was inhibited by 95±4% (mean±SD). By 8 hours, the average percent inhibition had decreased to 88±9%, with 13% of patients with <80% inhibition. The next morning (mean 19 hours after the bolus), mean inhibition was 71±14%. A difference was not found between diabetics and nondiabetics, nor was any physiological parameter found to be predictive of the response to abciximab.
Conclusions—Although the majority of patients achieve and
maintain 
80% platelet inhibition during the 12-hour infusion
with standard-dose abciximab, there is substantial variability among
patients. Diabetic status does not appear to influence this
variability.
Key Words: platelets • diabetes mellitus • abciximab • angioplasty
This article has been cited by other articles:
 |
|
 |
|
  E. Mahmud, J. J. Cavendish, S. Tsimikas, L. Ang, C. Nguyen, G. Bromberg-Marin, G. Schnyder, S. Keramati, V. Palakodeti, W. F. Penny, et al. Elevated Plasma Fibrinogen Level Predicts Suboptimal Response to Therapy With Both Single- and Double-Bolus Eptifibatide During Percutaneous Coronary Intervention J. Am. Coll. Cardiol., June 5, 2007; 49(22): 2163 - 2171. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Tucci, M. T. Ganter, C. R. Hamiel, R. Klaghofer, A. Zollinger, and C. K. Hofer Platelet function monitoring with the Sonoclot analyzer after in vitro tirofiban and heparin administration J. Thorac. Cardiovasc. Surg., June 1, 2006; 131(6): 1314 - 1322. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Cavallini and F. Chirillo Non-ST-elevation acute coronary syndromes management: a fresh look at glycoprotein IIb/IIIa inhibitors Eur. Heart J. Suppl., October 1, 2005; 7(suppl_K): K10 - K14. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. M.S.K.J. Ernst, H. Suryapranata, K. Miedema, R. J. Slingerland, J. P. Ottervanger, J. C.A. Hoorntje, A.T.M. Gosselink, J.-H. E. Dambrink, M.-J. de Boer, F. Zijlstra, et al. Achieved platelet aggregation inhibition after different antiplatelet regimens during percutaneous coronary intervention for ST-segment elevation myocardial infarction J. Am. Coll. Cardiol., September 15, 2004; 44(6): 1187 - 1193. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Patrono, B. Coller, G. A. FitzGerald, J. Hirsh, and G. Roth Platelet-Active Drugs: The Relationships Among Dose, Effectiveness, and Side Effects: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy Chest, September 1, 2004; 126(3_suppl): 234S - 264S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Roffi and E. J. Topol Percutaneous coronary intervention in diabetic patients with non-ST-segment elevation acute coronary syndromes Eur. Heart J., February 1, 2004; 25(3): 190 - 198. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. A. Reiter, F. Mayr, H. Blazicek, E. Galehr, P. Jilma-Stohlawetz, H. Domanovits, and B. Jilma Desmopressin antagonizes the in vitro platelet dysfunction induced by GPIIb/IIIa inhibitors and aspirin Blood, December 15, 2003; 102(13): 4594 - 4599. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. E. Mager, M. A. Mascelli, N. S. Kleiman, D. J. Fitzgerald, and D. R. Abernethy Simultaneous Modeling of Abciximab Plasma Concentrations and ex Vivo Pharmacodynamics in Patients Undergoing Coronary Angioplasty J. Pharmacol. Exp. Ther., December 1, 2003; 307(3): 969 - 976. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. P. Cannon Small molecule glycoprotein IIb/IIIa receptor inhibitors as upstream therapy in acute coronary syndromes: Insights from the TACTICS TIMI-18 trial J. Am. Coll. Cardiol., February 19, 2003; 41(4_Suppl_S): 43S - 48S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. B. Batchelor, T. R. Tolleson, Y. Huang, R. L. Larsen, R. M. Mantell, P. Dillard, M. Davidian, D. Zhang, W. J. Cantor, M. H. Sketch Jr, et al. Randomized COMparison of Platelet Inhibition With Abciximab, TiRofiban and Eptifibatide During Percutaneous Coronary Intervention in Acute Coronary Syndromes: The COMPARE Trial Circulation, September 17, 2002; 106(12): 1470 - 1476. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Roffi, D. J. Moliterno, B. Meier, E. R. Powers, C. L. Grines, P. M. DiBattiste, H. C. Herrmann, M. Bertrand, K. E. Harris, L. A. Demopoulos, et al. Impact of Different Platelet Glycoprotein IIb/IIIa Receptor Inhibitors Among Diabetic Patients Undergoing Percutaneous Coronary Intervention: Do Tirofiban and ReoPro Give Similar Efficacy Outcomes Trial (TARGET) 1-Year Follow-Up Circulation, June 11, 2002; 105(23): 2730 - 2736. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F.W.G. Leebeek, E. Boersma, C.P. Cannon, F.J.J. van de Werf, and M.L. Simoons Oral glycoprotein IIb/IIIa receptor inhibitors in patients with cardiovascular disease: why were the results so unfavourable Eur. Heart J., March 2, 2002; 23(6): 444 - 457. [Full Text] [PDF]
|
|
|
|
 |
|
 T. Kovesi and D. Royston Editorial I: Is there a bleeding problem with platelet-active drugs? Br. J. Anaesth., February 1, 2002; 88(2): 159 - 163. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Westerbacka, H. Yki-Jarvinen, A. Turpeinen, A. Rissanen, S. Vehkavaara, M. Syrjala, and R. Lassila Inhibition of Platelet-Collagen Interaction: An In Vivo Action of Insulin Abolished by Insulin Resistance in Obesity Arterioscler. Thromb. Vasc. Biol., January 1, 2002; 22(1): 167 - 172. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. S. Sabatine and E. Braunwald Will Diabetes Save the Platelet Blockers? Circulation, December 4, 2001; 104(23): 2759 - 2761. [Full Text] [PDF]
|
|
|
|
|
|
M. Roffi, D. P. Chew, D. Mukherjee, D. L. Bhatt, J. A. White, C. Heeschen, C. W. Hamm, D. J. Moliterno, R. M. Califf, H. D. White, et al. Platelet Glycoprotein IIb/IIIa Inhibitors Reduce Mortality in Diabetic Patients With Non-ST-Segment-Elevation Acute Coronary Syndromes Circulation, December 4, 2001; 104(23): 2767 - 2771. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. J. Topol, D. J. Moliterno, H. C. Herrmann, E. R. Powers, C. L. Grines, D. J. Cohen, E. A. Cohen, M. Bertrand, F.-J. Neumann, G. W. Stone, et al. Comparison of Two Platelet Glycoprotein IIb/IIIa Inhibitors, Tirofiban and Abciximab, for the Prevention of Ischemic Events with Percutaneous Coronary Revascularization N. Engl. J. Med., June 21, 2001; 344(25): 1888 - 1894. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. R. Steinhubl, J. D. Talley, G. A. Braden, J. E. Tcheng, P. J. Casterella, D. J. Moliterno, F. I. Navetta, P. B. Berger, J. J. Popma, G. Dangas, et al. Point-of-Care Measured Platelet Inhibition Correlates With a Reduced Risk of an Adverse Cardiac Event After Percutaneous Coronary Intervention : Results of the GOLD (AU-Assessing Ultegra) Multicenter Study Circulation, May 29, 2001; 103(21): 2572 - 2578. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F.-J. Neumann, W. Hochholzer, G. Pogatsa-Murray, A. Schomig, and M. Gawaz Antiplatelet effects of abciximab, tirofiban and eptifibatide in patients undergoing coronary stenting J. Am. Coll. Cardiol., April 1, 2001; 37(5): 1323 - 1328. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. J. Kereiakes, S. R. Steinhubl, K. Kottke-Marchant, D. J. Moliterno, M. Rosenthal, E. J. Topol, A. M. Lincoff, and B. S. Coller Attainment and Maintenance of Platelet Inhibition Through Standard Dosing of Abciximab in Patients Undergoing Percutaneous Coronary Intervention Response Circulation, December 19, 2000; 102 (25): e186 - e186. [Full Text] [PDF]
|
|
|
|
|
|
D. P. Chew and D. J. Moliterno A critical appraisal of platelet glycoprotein IIb/IIIa inhibition J. Am. Coll. Cardiol., December 1, 2000; 36(7): 2028 - 2035. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. L. Bhatt and E. J. Topol Current Role of Platelet Glycoprotein IIb/IIIa Inhibitors in Acute Coronary Syndromes JAMA, September 27, 2000; 284(12): 1549 - 1558. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. H. Lemmer Jr Clinical experience in coronary bypass surgery for abciximab-treated patients Ann. Thorac. Surg., August 1, 2000; 70(2): S33 - 37. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. A. Waldmann, R. Levy, and B. S. Coller Emerging Therapies: Spectrum of Applications of Monoclonal Antibody Therapy Hematology, January 1, 2000; 2000(1): 394 - 408. [Abstract] [Full Text] [PDF]
|
|