Glycoprotein IIb/IIIa antagonists

SummaryThe role of GP IIb/IIIa antagonists has been focused on patients with acute coronary syndromes undergoing PCI. In the ISAR-REACT 2 study abciximab given in patients with NSTEACS undergoing PCI already treated with 600 mg clopidogrel improved 30-day death and reinfarction rate in troponin positive patients. In the large EARLY-ACS trial upstream therapy with eptifibatide in high risk with NSTE-ACS did not improve ischaemic complications but was associated with an increase in bleeding complications. Therefore GP IIb/IIIa antagonists should be given after the initial angiography and the decision the perform PCI in troponin positive patients with NSTE-ACS.In patients with STEMI undergoing primary PCI the prehospital administration of tirofiban was associated with an improved myocardial reperfusion. In contrast in the BRAVE 3 trial abciximab in patients with pretreatment with 600 mg clopidogrel did not reduce infarct size or improve clinial outcome. Comparative trials evaluating the effectiveness of abciximab and the small molecules tirofiban and eptifibatide did not show any differences between the three GP IIb/IIIa antagoniosts.

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Glycoprotein IIb/IIIa Antagonists in Acute Coronary Syndromes Undergoing PCI: A Long Way to Select Optimal Agent and Route

ISRN Vascular Medicine ◽

10.5402/2011/141430 ◽

2011 ◽

Vol 2011 ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Paolo Emilio Puddu ◽

Michele Schiariti ◽

Raffaele Bugiardini

Keyword(s):

Small Molecules ◽

Acute Coronary Syndromes ◽

Primary Pci ◽

Antiplatelet Treatment ◽

New Agents ◽

St Segment Elevation ◽

Coronary Syndrome ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Coronary Syndromes

Antiplatelet treatment in patients with an acute coronary syndrome (ACS), without or with ST segment elevation myocardial infarction (STEMI), forces to keep the balance between potential threats and optimal clinical advantages. Apart from clopidogrel, glycoprotein (GP) IIb/IIIa inhibitors (abciximab and 2 small molecules, tirofiban and eptifibatide) have come to the clinical scene. Recent evidence (2009–2011) is reviewed pointing to pharmacoeconometric considerations of concern in times of budget restrictions worldwide. In ACS, when clopidogrel plus aspirin are on, there might be no advantage to add small molecules. Whereas in STEMI patients treated by primary PCI, all 3 GP IIb/IIIa antagonists might be superimposable, when only ACS is present and PCI is elective, definite distinction among the 3 agents, both pharmacoeconomically and pharmacodynamically, might be invoked. There are still points open to debate. Among these the route (upstream versus downstream) is still a matter of uncertainties. Moreover, theoretically, there might be differences not only between abciximab and small molecules (mostly superimposable) but also between tirofiban and eptifibatide (the former being potentially more potent). Thus, a long way is needed before a prominent agent among GPIIb/IIIa inhibitors may be selected. The game is still open, a role will be played soon by new agents.

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Emergency Coronary Artery Bypass Grafting in Patients with Acute Coronary Syndromes following Primary PCI: A Current Report of the North–Rhine–Westphalia Surgical Myocardial Infarction Registry

10.1055/s-0040-1705343 ◽

2020 ◽

Author(s):

M. Thielmann ◽

D. Wendt ◽

I. Slottosch ◽

H. Welp ◽

S. Martens ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery ◽

Acute Coronary Syndromes ◽

Artery Bypass ◽

Bypass Grafting ◽

Primary Pci ◽

The North ◽

Coronary Syndromes ◽

A Current ◽

Current Report

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Antiplatelet Therapy in Acute Coronary Syndromes

European Cardiology Review ◽

10.15420/ecr.2010.6.1.58 ◽

2010 ◽

Vol 6 (1) ◽

pp. 58

Author(s):

Sasha Koul ◽

David Erlinge ◽

◽

Keyword(s):

Platelet Function ◽

Acute Coronary Syndromes ◽

New Drugs ◽

Antiplatelet Drugs ◽

Bleeding Complications ◽

Great Promise ◽

Mortality Data ◽

Poor Responders ◽

Coronary Syndromes

Drugs inhibiting platelet function play a major role in the treatment of acute coronary syndromes (ACS). The first drug used, which is still considered the cornerstone of therapy today, is aspirin. Although very impressive in acutely decreasing rates of myocardial infarction as well as death, long-term data are scarce, despite our current recommendation for lifelong aspirin. The thienopyridines, most notably clopidogrel, are the next line of antiplatelet drugs. Well-documented data support the usage of clopidogrel for non-STEMI-ACS (NSTE-ACS). Although positive mortality data exist regarding clopidogrel and STEMI patients in a medically treated population, including thrombolysis, no larger amounts of randomised data exist in a primary PCI setting. Poor responders to aspirin and/or clopidogrel are a clinical problem, with these individuals constituting a higherrisk group for recurrent ischaemic events. Whereas very little can be done regarding aspirin resistance, clopidogrel resistance might be diminished by increasing the dosage or changing to more potent and newer-generation antiplatelet drugs. The role of glycoprotein IIb/IIIa inhibitors has diminished drastically and instead paved the way for thrombin antagonists (bivalirudin), which have fewer bleeding complications with resulting better long-term mortality. Novel adenosine diphosphate (ADP)-receptor blockers such as prasugrel and ticagrelor have shown increased efficacy over clopidogrel and hold great promise for the future. However, not all patients may benefit from these new drugs and economic constraints may also limit their use. Platelet function tests could possibly help in identifying risk groups in need of stronger platelet inhibition.

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