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Contraindications and cautions to GP IIb/IIIa antagonist administration

Thrombocytopenia

• Platelet count less than 100,000 is listed as a contraindication for abciximab and eptifibatide.
• Prior drug related thrombocytopenia is a contraindication to tirofiban.
• Platelet counts, beginning about 2 hours after initial administration, that fall below 100,000 are an indication to discontinue both the GP IIb/IIIa inhibitor and heparin.
• Usually, aspirin and clopidogrel can be continued.

Profound thrombocytopenia

• Eg < 20,000 platelets/mm3,
• Treat with platelet transfusion.
• Aspirin and clopidogrel may have to be discontinued until platelet count begins to recover.

Femoral artery catheters

• Arterial catheters can be removed during GP IIb/IIIa infusion if heparin has been discontinued and aPTT or ACT are acceptably low (eg aPTT < 45 seconds or ACT < 180 seconds).

Heparin

• Continued use after completion of successful percutaneous coronary intervention is discouraged for abciximab and eptifibatide.

General contraindications (also see individual drug summaries)

• Active bleeding within 30 days.
• Severe (uncontrolled) hypertension (> 180 - 200 / > 110).
• Major surgery within 6 weeks.
• Any stroke within 30 days (eptifibatide, tirofiban) 2 years (abciximab).
• Hemorrhagic stroke ever.
• Hypersensitivity to drug.
• Use of another IIb/IIIa inhibitor.

Reversal of antiplatelet activity and surgical intervention

• Eptifibatide & tirofiban: Drugs are cleared and effects gone within 2 to 4 hours. Platelet transfusions help little because any remaining drug will inhibit additional platelets.
• Abciximab: High affinity binding to existing platelets leaves little drug to interact with platelets subsequently given by transfusion. Platelet transfusions are expected to be helpful.
• Surgical intervention appears safe 2 to 4 hours after stopping eptifibatide or tirofiban.

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Disclaimer: Material is for discussion & review and is not advice or endorsement. Comments to Donald Vine MD.