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The emerging role of platelet glycoprotein IIb/IIIa inhibitors in managing high-risk patients with non-ST segment elevation acute coronary syndromes.
Curr Med Res Opin. 2007 Jun; 23(6):1217-26.CM

Abstract

BACKGROUND

Current practice guidelines recommend administering a platelet glycoprotein IIb/IIIa inhibitor, in conjunction with aspirin and heparin, for patients with non-ST segment elevation (NSTE) acute coronary syndromes (ACS) for whom an early invasive management strategy is planned. However, optimal timing of glycoprotein IIb/IIIa inhibitor administration - 'upstream' in the coronary care unit or 'downstream' when the patient goes to the catheterization laboratory - has not been established.

SCOPE

This paper evaluates recent trial results that help to better define the role of platelet glycoprotein IIb/IIIa inhibitors for treating high-risk patients with NSTE ACS who are scheduled for percutaneous coronary intervention (PCI). The Medline database was searched in February 2007 to retrieve relevant articles. Additional articles were obtained from the reference lists of retrieved articles, as well as from recent scientific meetings and company websites.

FINDINGS

Results of the ISAR-REACT 2 trial indicate that administration of abciximab provides significant benefit for high-risk patients with NSTE ACS undergoing PCI; clopidogrel alone is not enough. In preliminary results of the ACUITY trial, glycoprotein IIb/IIIa inhibitor administration produced an incremental increase in bleeding events but a reduction in ischemic events; there was a trend to better outcomes with upstream administration, even short-term. Moreover, in the cohort of patients who underwent PCI, the composite ischemic endpoint was significantly lower with routine upstream glycoprotein IIb/IIIa inhibitor. Finally, results of the EVEREST pilot study, a mechanistic study evaluating epicardial and tissue level perfusion and cardiac troponin I release, significantly favored upstream administration of tirofiban over downstream glycoprotein IIb/IIIa inhibitor for high-risk patients with NSTE ACS undergoing PCI. Moreover, high bolus dose tirofiban or abciximab administered just before PCI produced similar effects on angiographic outcome and cardiac troponin I release.

CONCLUSIONS

Recent and emerging evidence is clarifying the role of glycoprotein IIb/IIIa inhibitors in treating high-risk patients with NSTE ACS and indicates that these agents are of greatest benefit when given early.

Authors+Show Affiliations

Cardiovascular Department, Department of Cardiovascular Disease, Azienda Ospedaliera, Arezzo, Italy. leonardobolognese@hotmail.com

Pub Type(s)

Evaluation Study
Journal Article
Review

Language

eng

PubMed ID

17559721

Citation

Bolognese, Leonardo. "The Emerging Role of Platelet Glycoprotein IIb/IIIa Inhibitors in Managing High-risk Patients With non-ST Segment Elevation Acute Coronary Syndromes." Current Medical Research and Opinion, vol. 23, no. 6, 2007, pp. 1217-26.
Bolognese L. The emerging role of platelet glycoprotein IIb/IIIa inhibitors in managing high-risk patients with non-ST segment elevation acute coronary syndromes. Curr Med Res Opin. 2007;23(6):1217-26.
Bolognese, L. (2007). The emerging role of platelet glycoprotein IIb/IIIa inhibitors in managing high-risk patients with non-ST segment elevation acute coronary syndromes. Current Medical Research and Opinion, 23(6), 1217-26.
Bolognese L. The Emerging Role of Platelet Glycoprotein IIb/IIIa Inhibitors in Managing High-risk Patients With non-ST Segment Elevation Acute Coronary Syndromes. Curr Med Res Opin. 2007;23(6):1217-26. PubMed PMID: 17559721.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The emerging role of platelet glycoprotein IIb/IIIa inhibitors in managing high-risk patients with non-ST segment elevation acute coronary syndromes. A1 - Bolognese,Leonardo, Y1 - 2007/04/23/ PY - 2007/6/15/pubmed PY - 2008/7/10/medline PY - 2007/6/15/entrez SP - 1217 EP - 26 JF - Current medical research and opinion JO - Curr Med Res Opin VL - 23 IS - 6 N2 - BACKGROUND: Current practice guidelines recommend administering a platelet glycoprotein IIb/IIIa inhibitor, in conjunction with aspirin and heparin, for patients with non-ST segment elevation (NSTE) acute coronary syndromes (ACS) for whom an early invasive management strategy is planned. However, optimal timing of glycoprotein IIb/IIIa inhibitor administration - 'upstream' in the coronary care unit or 'downstream' when the patient goes to the catheterization laboratory - has not been established. SCOPE: This paper evaluates recent trial results that help to better define the role of platelet glycoprotein IIb/IIIa inhibitors for treating high-risk patients with NSTE ACS who are scheduled for percutaneous coronary intervention (PCI). The Medline database was searched in February 2007 to retrieve relevant articles. Additional articles were obtained from the reference lists of retrieved articles, as well as from recent scientific meetings and company websites. FINDINGS: Results of the ISAR-REACT 2 trial indicate that administration of abciximab provides significant benefit for high-risk patients with NSTE ACS undergoing PCI; clopidogrel alone is not enough. In preliminary results of the ACUITY trial, glycoprotein IIb/IIIa inhibitor administration produced an incremental increase in bleeding events but a reduction in ischemic events; there was a trend to better outcomes with upstream administration, even short-term. Moreover, in the cohort of patients who underwent PCI, the composite ischemic endpoint was significantly lower with routine upstream glycoprotein IIb/IIIa inhibitor. Finally, results of the EVEREST pilot study, a mechanistic study evaluating epicardial and tissue level perfusion and cardiac troponin I release, significantly favored upstream administration of tirofiban over downstream glycoprotein IIb/IIIa inhibitor for high-risk patients with NSTE ACS undergoing PCI. Moreover, high bolus dose tirofiban or abciximab administered just before PCI produced similar effects on angiographic outcome and cardiac troponin I release. CONCLUSIONS: Recent and emerging evidence is clarifying the role of glycoprotein IIb/IIIa inhibitors in treating high-risk patients with NSTE ACS and indicates that these agents are of greatest benefit when given early. SN - 1473-4877 UR - https://www.unboundmedicine.com/medline/citation/17559721/The_emerging_role_of_platelet_glycoprotein_IIb/IIIa_inhibitors_in_managing_high_risk_patients_with_non_ST_segment_elevation_acute_coronary_syndromes_ L2 - http://www.tandfonline.com/doi/full/10.1185/030079907X188143 DB - PRIME DP - Unbound Medicine ER -