Risk-benefit analysis of platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes.
Four intravenous glycoprotein IIb/IIIa receptor inhibitors (GPIs) (abciximab, eptifibatide, tirofiban and lamifiban) have been tested extensively over the last decade for their efficacy and safety in patients with acute coronary syndromes (ACS). GPIs are well-established adjunct agents for patients undergoing percutaneous coronary intervention, and considerable effort has gone into evaluating these agents in patients who are not scheduled to undergo coronary revascularisation. In the current article, six major randomised clinical trials conducted in the latter patient population are reviewed. Based on a recent meta-analysis of these trials, GPIs reduced the incidence of death or myocardial infarction in patients not scheduled for early revascularisation, with the greatest reduction observed in patients at high risk of thrombotic complications. Major bleeding complications were more frequent in those receiving GPIs, however, the incidences of intracranial haemorrhage and stroke were similar in both treatment groups. Despite these risks, the benefits of GPI therapy in addition to conventional treatment, such as aspirin and heparin, should be considered for these high-risk patients.
Westerhout
Cynthia M
CM
Erasmus Medical Centre, Room H543, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
Boersma
Eric
E
D000077284:Abciximab; D000085:Acetates / Q000191:economics / Q000627:therapeutic use; D000208:Acute Disease; D000911:Antibodies, Monoclonal / Q000191:economics / Q000627:therapeutic use; D003327:Coronary Disease / Q000188:drug therapy* / Q000503:physiopathology; D004341:Drug Evaluation; D000077542:Eptifibatide; D017408:Guidelines as Topic; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000191:economics / Q000627:therapeutic use; D015994:Incidence; D007275:Injections, Intravenous; D010455:Peptides / Q000191:economics / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000191:economics / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D018570:Risk Assessment; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000031:analogs & derivatives* / Q000191:economics / Q000627:therapeutic use
D000085:Acetates; D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; C084062:lamifiban; D000077466:Tirofiban; D000077542:Eptifibatide; D000077284:Abciximab