Inhibitors of the platelet receptor glycoprotein IIb-IIIa and complications during percutaneous coronary revascularization. Management strategies for the cardiac surgeon.
Platelet-mediated thrombosis has a pivotal role in the pathophysiology of acute ischemic coronary syndromes (AICS) and the acute complications of percutaneous coronary interventions. Because cross-linking of the activated platelet receptor glycoprotein (GP) IIb-IIIa by plasma fibrinogen represents the final common pathway to coronary thrombus formation, several GP IIb-IIIa inhibitors have been developed as a potentially more effective antithrombotic therapy than agents currently used for this purpose, namely aspirin and heparin. However, use of GP IIb-IIIa inhibitors in patients with AICS and those scheduled for percutaneous coronary interventions may increase the risk of serious clinical and bleeding events among patients who require emergency or urgent bypass surgery. This review describes clinical experience with various GP IIb-IIIa inhibitors and suggests management strategies for patients undergoing emergency or urgent bypass surgery shortly after treatment with GP IIb-IIIa inhibitors.
Dyke
C
C
Carolinas Heart Insitutute, Carolinas Medical Center, Charlotte, North Carolina, USA.
Bhatia
D
D
D002315:Cardiopulmonary Bypass; D001026:Coronary Artery Bypass; D003328:Coronary Thrombosis / Q000097:blood / Q000601:surgery*; D004305:Dose-Response Relationship, Drug; D004630:Emergencies; D000077542:Eptifibatide; D006488:Hemostasis, Surgical; D006801:Humans; D010455:Peptides / Q000008:administration & dosage / Q000009:adverse effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D016032:Randomized Controlled Trials as Topic; D000077466:Tirofiban; D014443:Tyrosine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives
D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; D000077466:Tirofiban; D000077542:Eptifibatide