• P E Greilich, B M Alving, D Longnecker, M E Carr, C W Whitten, A S Chang, and T J Reid.
• Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center-Dallas, USA.
• J. Cardiothorac. Vasc. Anesth. 1999 Feb 1;13(1):58-64.

ObjectiveThis investigation examines the hypothesis that the antiplatelet effect of abciximab and its reversal can be monitored using the Hemodyne (Hemodyne, Inc, Midlothian, VA) analyzer and modified Thrombelastograph (Haemoscope, Skokie, IL).DesignIn vitro dose-response and reversal study.SettingAnesthesia Research (Dallas, TX) and Special Studies Coagulation Laboratories (Washington, DC).ParticipantsNine healthy volunteers.InterventionsThe addition of increasing concentrations of abciximab, 0 to 10 microg/mL, and purified fibrinogen, 50 to 400 mg/dL. The reversal of abciximab, 4 microg/mL, with the addition of fresh platelet-rich plasma (PRP) sufficient to increase the platelet concentration by approximately 10%.Measurements And Main ResultsPlatelet aggregation and platelet contractile force using the Hemodyne analyzer were used as platelet-specific measurements. The Thrombelastograph maximum amplitude (MA) for platelets (MA(PLT)) was calculated by subtracting the MA from a platelet-poor plasma (PPP) sample (MA(ppp)) determined in one thromboelastography well from that of whole-blood MA (MA(WB)) run simultaneously in the second thromboelastography well. The addition of abciximab, 0 to 10 microg/mL, resulted in significant concentration-dependent reductions in platelet aggregation (p < 0.001), platelet contractile force (p < 0.001), and MA(PLT) (p < 0.001). Platelet contractile force (p < 0.03) and MA(PLT) (p < 0.05) were significantly more responsive than MA(WB) to the effect of abciximab, 4 microg/mL, and its reversal with the addition of fresh PRP. Purified fibrinogen concentration directly correlated with thromboelastography MA (r(s) = 0.97; p < 0.001), yet had no effect on platelet contractile force. The addition of abciximab had no measurable influence on the MA(ppp).ConclusionThis in vitro study suggests that the Hemodyne analyzer and modified Thrombelastograph might be clinically useful methods to monitor the platelet inhibitory effects of agents such as abciximab.

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