Drug Interaction Report

MONITOR CLOSELY: The intended and unintended effects of glycoprotein IIb/IIIa inhibitors and thrombolytic agents are additive, such that there is an increased frequency of major bleeding complications, including intracranial hemorrhage, retroperitoneal bleeding, spontaneous gastrointestinal (GI) and genitourinary (GU) bleeding among patients receiving both agents compared with the risk associated with the use of either agent alone. In one clinical trial, the risk of bleeding increased by twofold when abciximab was given after full-dose thrombolytics, while other studies have not reported an increased risk. Fatalities have occurred. Arterial puncture sites may be most problematic.

MANAGEMENT: It is recommended that these drugs be used together only when indicated by skilled personnel who are qualified and equipped to detect and treat bleeding complications. The successful use of combination therapy with glycoprotein IIb/IIIa inhibitors and reduced doses of thrombolytics has been reported in clinical trials. Patients should be closely monitored for signs of bleeding, especially at arterial puncture sites. Thrombolytic and/or glycoprotein inhibitor therapy should be discontinued immediately if serious or uncontrollable bleeding occurs.