Abciximab: een nieuwe plaatjesaggregatieremmer voor toepassing bij coronaire angioplastiek

Angioplasty of coronary arteries (PTCA) is an accepted treatment modality for patients with symptomatic coronary artery disease. Despite technological improvements it is still plagued by (mainly thrombotic) complications in around 10% of all patients. A number of new antithrombotic and antiplatelet agents have been tried in the setting of angioplasty. The monoclonal glycoprotein IIb-IIIa receptor blocker abciximab appears to control the thrombotic process most effectively before, during and after the procedure. Three large randomized trials with abciximab in patients with stable, unstable or refractory unstable angina pectoris were conducted. All three showed a relative reduction by 35% to 56% in the primary combined endpoint, consisting of mortality, myocardial infarction or urgent intervention, at 30 days. Severe bleeding, which affected 14.0% of patients on abciximab in the first trial, was reduced, after adjusting heparin dosing and issuing sheath removal guidelines, to 3.8% in the second and 2.0% in the final study. In the placebo groups the percentages of severe bleeding were 6.6, 1.9, and 3.1, respectively. Abciximab appears to reduce the thrombotic complications of PTCA substantially. The extent of this reduction and the severity of complications prevented justifies its more general use during angioplasty.