Drug Interaction Report

MONITOR CLOSELY: Although glycoprotein IIb/IIIa inhibitors are routinely given with heparin, be cognizant of the increased risk of bleeding due to additive pharmacologic effects. Data have shown increased incidences of major bleeding complications, including hemorrhagic stroke, 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. Arterial puncture sites may be most problematic. Fatal bleeding episodes have been reported. Some clinical trials have reported higher rates of hemorrhagic stroke in patients receiving abciximab plus standard heparin doses than in patients receiving low-dose, weight-adjusted heparin doses.

MANAGEMENT: Patients should be closely monitored for signs of bleeding, especially at arterial puncture sites. Glycoprotein inhibitor/heparin therapy should be discontinued immediately if serious or uncontrollable bleeding occurs or if thrombocytopenia is confirmed. Low-dose, weight-adjusted heparin is recommended in patients who are receiving abciximab and undergoing percutaneous coronary intervention. Heparin should be discontinued for 3 to 4 hours before removing the sheath.