title: Abciximab as a bridging strategy to overcome morphine-prasugrel interaction in STEMI patients.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Department of Cardiology, Medical University of Vienna, Vienna, Austria. jolanta.siller-matula@meduniwien.ac.at.
authors.forename: Jolanta M
authors.initials: JM
authors.lastname: Siller-Matula
authors.affiliation: Department of Cardiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Simon
authors.initials: S
authors.lastname: Specht
authors.affiliation: Department of Cardiology and Internal Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Kubica
authors.affiliation: Department of Cardiology, Patras University Hospital, Patras, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Alexopoulos
authors.affiliation: Institute of Cardiology, "G. d'Annunzio" University - Chieti-Pescara, Chieti, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: De Caterina
authors.affiliation: Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.
authors.forename: Eva-Luise
authors.initials: EL
authors.lastname: Hobl
authors.affiliation: Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.
authors.forename: Bernd
authors.initials: B
authors.lastname: Jilma
authors.affiliation: 5th Medical Department of Cardiology, Kaiser Franz Josef Hospital, Vienna, Austria.
authors.forename: Günter
authors.initials: G
authors.lastname: Christ
authors.affiliation: Department of Cardiology, Medical University of Vienna, Vienna, Austria.
authors.forename: Irene M
authors.initials: IM
authors.lastname: Lang
mesh_terms: D000077284:Abciximab; D000911:Antibodies, Monoclonal / Q000494:pharmacology*; D004347:Drug Interactions; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D009020:Morphine / Q000009:adverse effects*; D010974:Platelet Aggregation / Q000187:drug effects*; D010979:Platelet Function Tests; D000068799:Prasugrel Hydrochloride / Q000494:pharmacology*; D011446:Prospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000097:blood
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D009020:Morphine; D000068799:Prasugrel Hydrochloride; D000077284:Abciximab
keywords: abciximab; morphine; platelet; prasugrel