Abciximab (c7E3 Fab). A review of its pharmacology and therapeutic potential in ischaemic heart disease.

Abciximab (c7E3 Fab) is a chimaeric human-murine monoclonal antibody Fab (fragment antigen binding) fragment. It binds to the platelet glycoprotein IIb/IIIa receptor and inhibits platelet aggregation. In two double-blind placebo-controlled trials, abciximab therapy reduced the incidence of ischaemic complications during the initial postoperative period (30 days or until hospital discharge) in high-risk patients undergoing percutaneous coronary angioplasty or directional atherectomy. It also reduced the incidence of clinical restenosis compared with placebo during longer term (6 months) follow-up of these patients. Although abciximab delayed the need for coronary artery bypass graft surgery, it did not reduce the proportion of patients ultimately requiring this procedure. The drug was generally well tolerated in clinical trials, with bleeding complications being the major adverse event. Abciximab is at an early stage of its clinical introduction and, not surprisingly, some aspects of its use remain to be further assessed. Nevertheless, results show the addition of abciximab to standard aspirin plus heparin therapy during coronary angioplasty or directional atherectomy improves the outcome of the revascularisation procedure in patients with a high risk of subsequent acute ischaemic complications. The results of further trials defining the optimum dosage of heparin when administered with abciximab, and evaluating the role of abciximab in a wider range of patients, are eagerly awaited.