Thursday, December 29, 2005

Thursday December 29, 2005
ReoPro and Integrilin (Glycoprotein 2b/3a Receptor Inhibitors)

Although our cardiology colleauges mostly take care of intravenous antiplatelet therapy in acute situations but atleast to be aware of basic differences between 2 widely used iv antiplatelet agents.

ReoPro (abciximab): is a large molecule agent and binds irreversibly to Gp2b/3a receptors of platelets and so clinical effect lasts for 7 to 10 days and for same reason needs platelet transfusion in case of bleeding. ReoPro is usually given in STEMI ( ST elevated - Myocardial infarction). It may cause severe thrombocytopenia within hours of infusion.

Integrilin (eptifibatide): is a small molecule and binds reversibly to Gp2b/3a receptors of platelets and so clinical effect lasts for only 4 to 6 hours. Platelet transfusion is not required and should be avoided in case of bleeding as it may inhibits new platelet formation. Integrilin is usually given in NSTE-ACS (Non ST elevation - acute coronary syndrome). It is 50% cleared by kidney. Also dosing is weight dependent. Dosing chart is available in package insert. 4

Avoid unnecessary IV or IM sticks while patient on Gp2b/3a infusion.

References: Click to get abstract or article

ABCIXIMAB - Stanford University Interventional Cardiology
EPTIFIBATIDE - Stanford University Interventional Cardiology
A Clinical Trial of Abciximab in Elective Percutaneous Coronary Intervention after Pretreatment with Clopidogrel - NEJM, Jan. 2004 Volume 350:232-238
Integrilin - package insert
Abciximab as Adjunctive Therapy to Reperfusion in Acute ST-Segment Elevation Myocardial Infarction - JAMA Vol. 293 No. 14, April 13, 2005