BACKGROUND: Platelet GP IIb/IIIa blockade with abciximab (ABC) substantially improves the safety of coronary stenting procedures. Current protocols for the use of ABC are based on results from the initial EPIC study where less than 2% of patients received a first generation coronary stent. This pilot clinical study assessed the hypothesis that an intravenous bolus of ABC only without infusion is safe and effective in patients undergoing percutaneous coronary interventions (PCI) with routine modern stent implantation.

METHODS: We studied 121 patients who underwent elective or urgent PCI. All patients had lesions that were dilated and stented. Patients presenting with an acute MI or with a visible thrombus on coronary angiography were excluded. Sixty one consecutive patients received ABC bolus only (0.25 mg/kg) and heparin (70 U/kg, with additional boluses to attain an ACT of at least 250 s) 10 minutes prior to PCI and 60 matched patients received the conventional treatment of bolus and infusion of ABC with the same regimen of heparin. Routine CK, Hb/Ht, and Platelet count were obtained prior to and at 6, 12, 18-24 hours after the procedure. Direct costs for each procedure were recorded.

RESULTS: See table. The single ABC bolus regimen saves $635.00 (CDN) per patient compared to a bolus and infusion regimen.

CONCLUSIONS: This pilot study suggests that abciximab administered as a single bolus during routine stenting is feasible. Bleeding and thrombotic complications are rare and cost savings substantial. Event rates are similar in both groups. Further controlled studies are warranted to evaluate the efficacy of a single intravenous abciximab bolus regimen compared to the usual abciximab regimen of bolus and infusion with routine coronary stenting.

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