Abciximab as a bridging strategy to overcome morphine–prasugrel interaction in STEMI patients

• Published in: British journal of clinical pharmacology Vol. 82; no. 5; pp. 1343 - 1350
• Main Authors: Siller‐Matula, Jolanta M., Specht, Simon, Kubica, Jacek, Alexopoulos, Dimitrios, De Caterina, Raffaele, Hobl, Eva‐Luise, Jilma, Bernd, Christ, Günter, Lang, Irene M.
• Format: Journal Article
• Language: English
• Published: England John Wiley and Sons Inc 01-11-2016
• Subjects: Abciximab; Antibodies, Monoclonal - pharmacology; Drug Interactions; Female; Humans; Immunoglobulin Fab Fragments - pharmacology; Male; Middle Aged; morphine; Morphine - adverse effects; platelet; Platelet Aggregation - drug effects; Platelet Function Tests; prasugrel; Prasugrel Hydrochloride - pharmacology; Prospective Studies; ST Elevation Myocardial Infarction - blood; platelet; prasugrel; abciximab; morphine
• ISSN: 0306-5251; 1365-2125
• DOI: 10.1111/bcp.13053

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.