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Editorial Comment Readministration of Abciximab: Weighing the Risks and Benefits Joel K. Kahn, MD William Beaumont Hospital, Royal Oak, Michigan I have found glycoprotein receptor inhibitors to be the most exciting advance in the interventional catheteriza- tion suite since coronary stents. My own use of these agents has increased substantially in the last few years as the results of excellent clinical trials have become available and the safety of administration has improved. It is inevitable that many patients treated with abciximab and other glycoprotein inhibitors will require further interventional procedures, but is it safe to repeat the administration of these agents? Arjomand et al. contribute a single-center experience with the readministration of abciximab in 35 patients undergoing percutaneous coronary interventions. There was no anaphylaxis, there was one incident of severe thrombocytopenia without bleeding, and there were no abrupt closures. These data join prior reports and indicate that it is reasonable to consider readministering glycopro- tein receptor inhibitors. I think it is important to develop protocols to check automatically platelet counts before, approximately 4 hr, and again 12–24 hr after interven- tions. Sudden and profound thrombocytopenia reported with abciximab should be monitored for with extra vigilance in the patient receiving these agents for a second or third time. After reading the report by Arjomand et al. I feel more comfortable making the decision to give abciximab on multiple occasions in the same patient. Furthermore, it is often unknown whether a patient with a prior interven- tional procedure was administered a glycoprotein recep- tor blocker, particularly if it was performed at a different hospital. I am not certain that the final word is in, however. Only a larger published experience can give a true reflection of the risk of anaphylaxis and thrombocy- topenia. The effectiveness of platelet inhibition following the readministration of abciximab and other agents needs to be determined. Assays of platelet inhibition are avail- able and could be used to answer this question in vitro. Only a randomized trial will answer the question ad- equately in clinical practice. Finally, now that several glycoprotein receptor inhibitors are commercially avail- able, it is unknown if it is safer or more effective to give a different agent the second time a patient is offered this therapy. Catheterization and Cardiovascular Interventions 47:297 (1999) r 1999 Wiley-Liss, Inc.

Readministration of abciximab: Weighing the risks and benefits

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Editorial Comment

Readministration of Abciximab:Weighing the Risks and Benefits

Joel K. Kahn, MD

William Beaumont Hospital,Royal Oak, Michigan

I have found glycoprotein receptor inhibitors to be themost exciting advance in the interventional catheteriza-tion suite since coronary stents. My own use of theseagents has increased substantially in the last few years asthe results of excellent clinical trials have becomeavailable and the safety of administration has improved.It is inevitable that many patients treated with abciximaband other glycoprotein inhibitors will require furtherinterventional procedures, but is it safe to repeat theadministration of these agents?

Arjomand et al. contribute a single-center experiencewith the readministration of abciximab in 35 patientsundergoing percutaneous coronary interventions. Therewas no anaphylaxis, there was one incident of severethrombocytopenia without bleeding, and there were noabrupt closures. These data join prior reports and indicatethat it is reasonable to consider readministering glycopro-tein receptor inhibitors. I think it is important to develop

protocols to check automatically platelet counts before,approximately 4 hr, and again 12–24 hr after interven-tions. Sudden and profound thrombocytopenia reportedwith abciximab should be monitored for with extravigilance in the patient receiving these agents for asecond or third time.

After reading the report by Arjomand et al. I feel morecomfortable making the decision to give abciximab onmultiple occasions in the same patient. Furthermore, it isoften unknown whether a patient with a prior interven-tional procedure was administered a glycoprotein recep-tor blocker, particularly if it was performed at a differenthospital. I am not certain that the final word is in,however. Only a larger published experience can give atrue reflection of the risk of anaphylaxis and thrombocy-topenia. The effectiveness of platelet inhibition followingthe readministration of abciximab and other agents needsto be determined. Assays of platelet inhibition are avail-able and could be used to answer this question in vitro.Only a randomized trial will answer the question ad-equately in clinical practice. Finally, now that severalglycoprotein receptor inhibitors are commercially avail-able, it is unknown if it is safer or more effective to give adifferent agent the second time a patient is offered thistherapy.

Catheterization and Cardiovascular Interventions 47:297 (1999)

r 1999 Wiley-Liss, Inc.