Combination reperfusion therapy with abciximab and reduced dose reteplase: results from TIMI 14

Aims Abciximab has previously been shown to enhance thrombolysis and improve myocardial perfusion when combined with reduced doses of alteplase. The purpose of the reteplase phase of TIMI 14 was to evaluate the effects of abciximab when used in combination with a reduced dose of reteplase for ST-elevation myocardial infarction. Methods and Results Patients (n=299) with ST-elevation myocardial infarction were treated with aspirin and randomized to a control arm with standard dose reteplase (10+10U given 30min apart) or abciximab (bolus of 0·25mg.kg−1and 12-h infusion of 0·125μg.kg−1.min−1) in combination with reduced doses of reteplase (5+5U or 10+5U). Control patients received standard weight-adjusted heparin (bolus of 70U.kg−1; infusion of 15U.kg−1.h−1), while each of the combination arms with abciximab and reduced dose reteplase received either low dose heparin (bolus of 60U.kg−1; infusion of 7U.kg−1.h−1) or very low dose heparin (bolus of 30U.kg−1; infusion of 4U.kg−1.h−1). The rate of TIMI 3 flow at 90min was 70% for patients treated with 10+10U of reteplase alone (n=87), 73% for those treated with 5+5U of reteplase with abciximab (n=88), and 77% for those treated with 10+5U of reteplase with abciximab (n=75). Complete (≥70%) ST resolution at 90min was seen in 56% of patients receiving a reduced dose of reteplase in combination with abciximab compared with 48% of patients receiving reteplase alone. Conclusions Reduced doses of reteplase when administered in combination with abciximab were associated with higher TIMI 3 flow rates than reported previously for reduced doses of reteplase without abciximab and were at least as high as for full dose reteplase alone