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Abciximab as a bridging strategy to overcome morphine–prasugrel interaction in STEMI patients
Author(s) -
SillerMatula Jolanta M.,
Specht Simon,
Kubica Jacek,
Alexopoulos Dimitrios,
De Caterina Raffaele,
Hobl EvaLuise,
Jilma Bernd,
Christ Günter,
Lang Irene M.
Publication year - 2016
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1111/bcp.13053
Subject(s) - prasugrel , abciximab , medicine , morphine , platelet , myocardial infarction , pharmacology , anesthesia , clopidogrel , percutaneous coronary intervention
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.