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Ischemic Stroke
Case series
Half bolus dose of intravenous abciximab is safe and effective in the setting of acute stroke endovascular treatment
  1. Fernando Delgado1,
  2. Rafael Oteros1,
  3. Elvira Jimenez-Gomez1,
  4. Isabel Bravo Rey1,
  5. María Dolores Bautista2,
  6. Roberto Valverde Moyano3
  1. 1 Diagnostic and Therapeutical Neuroradiology Unit, Hospital Reina Sofía, Córdoba, Spain
  2. 2 Intensive Care Unit, Hospital Universitario Reina Sofia, Córdoba, Spain
  3. 3 Neurology Unit, Hospital Reina Sofía, Córdoba, Spain
  1. Correspondence to Dr Fernando Delgado, Diagnostic and Therapeutical Neuroradiology Unit, Hospital Reina Sofía, Córdoba 14004, Spain; fdelgado.neuro{at}gmail.com

Abstract

Background A stent is often necessary for the treatment of stroke. In such cases,it is essential for the patient to have antiplatelet therapy. There are several methods of antiaggregation, such as oral loading doses of aspirin and clopidogrel, intravenous aspirin, or intravenous glycoprotein IIb/IIIa receptor antagonists, such as abciximab. The aim of this study was to evaluate the incidence of symptomatic intracerebral hematoma (sICH) associated with our antiplatelet protocol: intravenous abciximab bolus at half the dose (0125 mg/kg) at the time of the stenting procedure; oral aspirin (150 mg) and clopidogrel (75 mg) daily added the next day after CT shows no significant hematoma.

Materials and methods Retrospective review of our database of endovascular management of large acute vessel occlusion treated with intravenous abciximab between January 2015 and March 2018. Demographics data, material, drugs, and complications were registered. Fisher tests were used to compare the incidence of sICH in the literature where abciximab 0.25 mg/kg plus maintenance doses are often administrated.

Results Intravenous abciximab was administered to 99 patients. No sICH was observed. According to the European Cooperative Acute Stroke Study Scale, there were 8 cases of hemorrhagic infarction 1, 5 cases of hemorrhagic infarction 2, 4 cases of parenchymal hemorrhage 1, and no cases of parenchymal hemorrhage 2. A comparison between sICH with conventional antiplatelet doses based on the literature showed a statistically significant difference favoring our protocol.

Conclusion In the endovascular treatment of acute ischemic stroke, a bolus dose of 0125 mg/kg of abciximab with no maintenance doses, followed by 150 mg of aspirin and 75 mg of clopidogrel orally the next day, is safe and effective.

  • drug
  • hemorrhage
  • stent
  • stroke
  • thrombectomy

https://doi.org/10.1136/neurintsurg-2018-014163

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    Footnotes

    • Contributors FD designed the data collection tools, monitored the data collection, wrote the statistical analysis plan, analyzed the data, and drafted and revised the paper. RO designed the data collection tools, monitored the data collection, and revised the paper. EJ-G analyzed the data and revised the paper. IBR monitored the data collection and revised the paper. MDB monitored the data collection and revised the draft paper. RVM monitored the data collection and revised the paper.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval The study was approved by the Comité de Ëtica de la Investigación de Córdoba.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement N/A.