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Administration of abciximab to patients receiving tirofiban or eptifibatide: effect on platelet function

^a The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York, USA

View larger version (13K): [in a new window]   Figure 1 Residual platelet function assessed by 20 µM ADP-induced aggregation (top) and flow cytometry analysis of fibrinogen-platelet binding (bottom) in 25 patients who received tirofiban followed by abciximab and in 10 patients who received only abciximab. Results are expressed as mean ± SEM percent of baseline aggregation. Administration of abciximab to tirofiban-treated patients caused a significant decrease in platelet function. Open square = tirofiban-abciximab group; solid circle = abciximab control group. Abx = abciximab; Maint = maintenance; Tir = tirofiban.

View larger version (32K): [in a new window]   Figure 2 Photomicrographs of the cone and platelet analyzer results in a representative tirofiban-abciximab patient. This method assesses platelet deposition at a high shear rate, and the results are expressed as the percentage of total surface covered by platelets. Micrograph (A) was taken at baseline (12.1% coverage), (B) after tirofiban bolus (2.2% coverage) and (C) after abciximab bolus, when tirofiban was still being infused (0.1% coverage). All micrographs were taken at magnification x10.

View larger version (13K): [in a new window]   Figure 3 Residual platelet function assessed by 20 µM ADP induced aggregation (top) and flow cytometry analysis of fibrinogen-platelet binding (bottom) in 10 patients who received eptifibatide followed by abciximab and in five patients who received only abciximab. Results are expressed as mean ± SEM percent of baseline aggregation. A significant decrease in platelet function after the abciximab bolus was evidenced only by the fibrinogen-binding assay. Open square = eptifibatide-abciximab group; solid circle = abciximab control group. Abx = abciximab; Ept = eptifibatide; Maint = maintenance.

View larger version (17K): [in a new window]   Figure 4 Binding of the monoclonal antibodies Mab1 and Mab2 to glycoprotein IIb/IIIa receptors on platelets. Mab1 is displaced by abciximab, whereas Mab2 is displaced by small molecule glycoprotein IIb/IIIa inhibitors. Results are expressed as mean ± SEM binding sites per platelet in four patients from the tirofiban-abciximab group (top) and four patients from the eptifibatide-abciximab group (bottom). The abciximab bolus caused a marked decrease in Mab1 binding and a concurrent increase in Mab2 binding in both groups. Open square = Mab1; solid circle = Mab2. Abx = abciximab; Ept = eptifibatide; Maint = maintenance; Tir = tirofiban.