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Br J Clin Pharmacol. 2016 Nov;82(5):1343-1350. doi: 10.1111/bcp.13053. Epub 2016 Jul 24.

Abciximab as a bridging strategy to overcome morphine-prasugrel interaction in STEMI patients.

Author information

1
Department of Cardiology, Medical University of Vienna, Vienna, Austria. jolanta.siller-matula@meduniwien.ac.at.
2
Department of Cardiology, Medical University of Vienna, Vienna, Austria.
3
Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
4
Department of Cardiology, Patras University Hospital, Patras, Greece.
5
Institute of Cardiology, "G. d'Annunzio" University - Chieti-Pescara, Chieti, Italy.
6
Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.
7
5th Medical Department of Cardiology, Kaiser Franz Josef Hospital, Vienna, Austria.

Abstract

OBJECTIVE:

The present study investigated whether the glycoprotein (GP)IIb/IIIa receptor blocker abciximab might be a successful bridging strategy to achieve adequate levels of platelet inhibition rapidly in cases where prasugrel is used in morphine-pretreated ST-elevation myocardial infarction (STEMI) patients.

METHODS:

In a prospective observational cohort study, 32 patients presenting with STEMI were given prasugrel at a loading dose of 60 mg. Patients were stratified into four groups, according to morphine and/or abciximab use. Adenosine diphosphate (ADP)-induced platelet aggregation was measured at four time points: at baseline, and at 2 h, 1 day and 2 days after prasugrel loading.

RESULTS:

Morphine use was associated with a three-fold higher level of ADP-induced platelet aggregation 2 h after prasugrel loading compared with no morphine/no abciximab (P = 0.019). However, when abciximab was infused in the catheterization laboratory, the effect of morphine on ADP-induced platelet aggregation disappeared (P = 0.884). This interaction was also seen in the presence of high on-treatment platelet reactivity (HTPR) at 2 h; while HTPR was seen in 88% of morphine users/no abciximab users, it was found in only 17-20% in the three other groups (P = 0.003). The effect of morphine disappeared by day 1 - 2.

CONCLUSION:

The infusion of the GPIIb/IIIa receptor blocker abciximab allows immediate and efficient platelet inhibition in STEMI patients concomitantly receiving the oral ADP receptor blocker prasugrel and morphine.

KEYWORDS:

abciximab; morphine; platelet; prasugrel

PMID:
27366874
PMCID:
PMC5061801
DOI:
10.1111/bcp.13053
[Indexed for MEDLINE]
Free PMC Article

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