The Therapeutic Potential of Abcirximab (c7E3 Fab) in Percutaneous Transluminal Coronary Angioplasty: Implications of the EPIC Study

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Abcirximab (c7E3 Fab) is a chimaeric mouse/human antibody fragment that binds specifically to the platelet receptor for fibrinogen and von Willebrand factor, preventing platelet aggregation. It is potentially useful for the treatment of thrombotic arterial diseases and for the prevention of thrombotic complications of coronary artery disease or its therapy.

The EPIC (Evaluation of platelet IIb/IIIa antibody for Preventing Ischaemic Complications of high-risk angioplasty) trial was designed to test the efficacy of abcirximab in preventing ischaemic complications of high-risk angioplasty procedures. Investigators found that the incidence of periprocedural myocardial infarction and the need for emergency repeat percutaneous transluminal coronary angioplasty or coronary artery bypass graft was reduced by 35%. This benefit was achieved at the cost of a 14% incidence of major bleeding complications (twice that seen in control patients) and rare temporary thrombocytopenia which was unrelated to the dose of abcirximab administered.

The results of the EPIC trial establish the usefulness of abcirximab as an adjunct to current therapies for avoiding ischaemic complications of angioplasty in patients with recent myocardial infarction, unstable angina or high-risk lesion morphology. Its utility in routine angioplasty procedures may be limited by the frequency of bleeding complications. The effects of its use on the development of restenosis after angioplasty, and on arterial patency after thrombolysis, remain to be tested.

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