Thuraisingham S, Tan K H
Department of Medicine, University Hospital, Kuala Lumpur, Malaysia.
Int J Clin Pract. 1999 Dec;53(8):604-7.
Direct coronary angioplasty with stent implantation is an effective treatment for acute myocardial infarction. The use of adjunctive abciximab, a platelet glycoprotein IIb/IIIa receptor antagonist is expensive. We report on three cases of direct coronary angioplasty complicated by extensive thrombus formation that were successfully treated with attenuated dosing of abciximab via the intracoronary route. All patients presented with acute myocardial infarction complicated by cardiogenic shock or eminent cardiogenic shock. Abciximab was administered after balloon dilatation when extensive thrombus formation was noted and persisted despite repeated inflations. In all three patients a single 10 mg vial of intracoronary abciximab was administered, resulting in complete dissolution of thrombus, allowing successful deployment of stents. Thus, a single 10 mg intracoronary bolus dose of abciximab may be sufficient to achieve high local concentrations of antiplatelet activity. This facilitates thrombus dissolution and allows the safe deployment of a stent to normalise intracoronary rheology.
直接冠状动脉血管成形术联合支架植入术是治疗急性心肌梗死的有效方法。辅助使用阿昔单抗（一种血小板糖蛋白IIb/IIIa受体拮抗剂）费用昂贵。我们报告了3例直接冠状动脉血管成形术并发广泛血栓形成的病例，通过冠状动脉内途径减少阿昔单抗剂量成功治疗。所有患者均表现为急性心肌梗死并发心源性休克或严重心源性休克。当发现广泛血栓形成且反复球囊扩张后仍持续存在时，在球囊扩张后给予阿昔单抗。在所有3例患者中，均给予单瓶10mg冠状动脉内阿昔单抗，导致血栓完全溶解，从而成功植入支架。因此，单次10mg冠状动脉内推注剂量的阿昔单抗可能足以实现高局部浓度的抗血小板活性。这有助于血栓溶解，并允许安全植入支架以使冠状动脉血流动力学正常化。
