Safety of glycoprotein IIb/IIIa inhibitors in urgent or emergency coronary artery bypass graft surgery.
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.
Cheng
Doret K F
DK
General Medicine, Mount Sinai Hospital, Toronto, Ontario. dcheng@mtsinai.on.ca
Jackevicius
Cynthia A
CA
Seidelin
Peter
P
Feindel
Chris
C
Rouleau
Jean Lucien
JL
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
D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex