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Keywords:

Adolescent, Adult, Aged, Antibodies, Monoclonal, Canada, Coronary Angiography, Drug Administration Schedule, Drug Therapy, Combination, Electrocardiography, Europe, Female, Heparin, Humans, Immunoglobulin Fab Fragments, Male, Middle Aged, Myocardial Infarction, Plasminogen Activators, Platelet Aggregation Inhibitors, Platelet Glycoprotein GPIIb-IIIa Complex, Recombinant Proteins, Thrombolytic Therapy, Tissue Plasminogen Activator, Treatment Outcome, United States, Science & Technology, Life Sciences & Biomedicine, Cardiac & Cardiovascular Systems, Cardiovascular System & Cardiology, thrombolysis, acute MI, glycoprotein IIb/IIIa inhibition, antiplatelet therapy, ACUTE MYOCARDIAL-INFARCTION, TISSUE-PLASMINOGEN-ACTIVATOR, SEGMENT ELEVATION RESOLUTION, CORONARY THROMBOLYSIS, STRONG PREDICTOR, TRIAL, EXTENT, ANGIOPLASTY, FLOW, Abciximab, 1102 Cardiorespiratory Medicine and Haematology, 1103 Clinical Sciences, Cardiovascular System & Hematology, 3201 Cardiovascular medicine and haematology, 3202 Clinical sciences

Abstract:

Aims Abciximab has previously been shown to enhance thrombolysis and improve myocardial perfusion when combined with reduced doses of alteplase. The purpose of the reteplase phase of TIMI 14 was to evaluate the effects of abciximab when used in combination with a reduced dose of reteplase for ST-elevation myocardial infarction. Methods and Results Patients (n=299) with ST-elevation myocardial infarction were treated with aspirin and randomized to a control arm with standard dose reteplase (10+10 U given 30 min apart) or abciximab (bolus of 0.25 mg. kg(-1)and 12-h infusion of 0.125 microg. kg(-1). min(-1)) in combination with reduced doses of reteplase (5+5 U or 10+5 U). Control patients received standard weight-adjusted heparin (bolus of 70 U. kg(-1); infusion of 15 U. kg(-1). h(-1)), while each of the combination arms with abciximab and reduced dose reteplase received either low dose heparin (bolus of 60 U. kg(-1); infusion of 7 U. kg(-1). h(-1)) or very low dose heparin (bolus of 30 U. kg(-1); infusion of 4 U. kg(-1). h(-1)). The rate of TIMI 3 flow at 90 min was 70% for patients treated with 10+10 U of reteplase alone (n=87), 73% for those treated with 5+5 U of reteplase with abciximab (n=88), and 77% for those treated with 10+5 U of reteplase with abciximab (n=75). Complete (>/=70%) ST resolution at 90 min was seen in 56% of patients receiving a reduced dose of reteplase in combination with abciximab compared with 48% of patients receiving reteplase alone.Conclusions Reduced doses of reteplase when administered in combination with abciximab were associated with higher TIMI 3 flow rates than reported previously for reduced doses of reteplase without abciximab and were at least as high as for full dose reteplase alone Copyright 2000 The European Society of Cardiology.