title: Safety of glycoprotein IIb/IIIa inhibitors in urgent or emergency coronary artery bypass graft surgery.
abstract: Approximately 2% to 4% of patients undergo urgent or emergency coronary artery bypass grafting (CABG) for complications of percutaneous coronary intervention (PCI) after treatment with glycoprotein (GP) IIb/IIIa inhibitors. The pharmacokinetic and pharmacodynamic properties of GP IIb/IIIa inhibitors play a large role in determining the safety of their use in the setting of urgent or emergency CABG procedures. Emergency or urgent CABG after treatment with the GP IIb/IIIa inhibitor, abciximab, may be associated with increased risk of hemorrhage and the requirement of platelet transfusions if surgery is performed within 12 h of abciximab discontinuation. Eptifibatide is associated with a similar risk compared with placebo, even when surgery is performed within 2 h of eptifibatide cessation. Limited data for tirofiban show that bleeding is not increased when compared with acetylsalicylic acid or heparin. Eptifibatide and tirofiban appear to have favourable safety profiles compared with abciximab in the setting of emergency or urgent CABG after failed PCI.
authors.affiliation: General Medicine, Mount Sinai Hospital, Toronto, Ontario. dcheng@mtsinai.on.ca
authors.forename: Doret K F
authors.initials: DK
authors.lastname: Cheng
authors.forename: Cynthia A
authors.initials: CA
authors.lastname: Jackevicius
authors.forename: Peter
authors.initials: P
authors.lastname: Seidelin
authors.forename: Chris
authors.initials: C
authors.lastname: Feindel
authors.forename: Jean Lucien
authors.initials: JL
authors.lastname: Rouleau
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D002986:Clinical Trials as Topic; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000453:epidemiology / Q000628:therapy; D004632:Emergency Medical Services; D006801:Humans; D015994:Incidence; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors* / Q000627:therapeutic use*; D012086:Reoperation; D012307:Risk Factors
chemical_list: D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex