Low-Dose Abciximab Promising in Patients With Large-Vessel Posterior Stroke Who Are Ineligible for tPA: Presented at ICS

By Thomas S. May
NASHVILLE, Tennessee -- February 12, 2015 -- Low-dose abciximab appears to be a safe and effective treatment for patients who have had posterior circulation strokes and present for treatment outside the window of eligibility for intravenous (IV) tissue plasminogen activator (tPA), according to a study presented at the 2015 International Stroke Conference (ISC).

“Proven options to treat ischaemic stroke patients ineligible for IV tPA are limited, and there is some evidence that glycoprotein (GP) IIb/IIIa inhibitors combined with heparin may help increase vascular patency,” stated lead author Pitchaiah Mandava, MD, PhD, Baylor College of Medicine, Houston, Texas, speaking here at a poster presentation on February 11.

Dr. Mandava and colleagues conducted their study to assess whether low-dose IV abciximab in combination with heparin may improve functional outcome in 26 patients with non-lacunar strokes in the posterior circulation who were ineligible for IV tPA based on either the time window from stroke occurrence (24 hours, later changed to 12 hours) or international normalised ratio INR < 2.5.

Subjects received low-dose IV abciximab (0.2 mg/kg IV bolus, followed by 0.05 µg/kg/hr infusion over 12 hours) within 12 hours of symptom onset. A weight-based heparin protocol was used in most patients to achieve the partial thromboplastin time of 46 to 70 seconds.

To assess benefit, patients’ baseline characteristics were compared with those of subjects from the National Institute of Neurological Disorders and Stroke (NINDS) study control arm (restricted to patients with large-vessel and cardioembolic stroke subtypes). The researchers compared 90-day modified Rankin scale (mRS) scores, as well as rates of mortality and haemorrhage between study participants and control subjects.

Analysis of the results demonstrates that 90-day functional outcomes were better in the abciximab group. For those with mRS scores from 0 to 1, reflecting no significant disability, results were 54.5% versus 23.1% in favour of abciximab, and for those with mRS scores from 0 to 2, reflecting slight disability, results were 63.6% versus 30.8% in favour of abciximab (P <.008). Mortality was higher in the NINDS control group (nonsignificant), while symptomatic haemorrhage rate was higher among patients receiving abciximab (nonsignificant).

“Since low-dose abciximab achieves sufficient platelet inhibition, and the combination with short-term heparin appears well tolerated, we suggest these findings warrant confirmation in a prospective randomised controlled trial, given the lack of proven alternatives for patients not eligible for intravenous tPA,” the researchers concluded.
[Presentation title: Multi-Center Experience With Low Dose Intravenous Abciximab in Large Vessel Posterior Circulation Stroke. Abstract MP30]

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