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.