title: Role of platelet glycoprotein IIb/IIIa inhibitors in rescue percutaneous coronary interventions.
abstract: In the setting of acute myocardial infarction, thrombolytic therapy fails to restore an adequate epicardial flow in a large number of patients. Although an increasing number of patients undergoes a percutaneous coronary intervention (PCI) after failed thrombolysis, this treatment has been poorly investigated. This review focuses particularly on the safety and prognostic impact of glycoprotein (GP) IIb/IIIa receptor inhibitors after failed thrombolysis. GPIIb/IIIa inhibitors have been demonstrated to improve the clinical outcome in patients undergoing primary PCI. However, the increased risk of bleeding with the administration of potent antiplatelet drugs after full-dose thrombolytics has limited the widespread use of GPIIb/IIIa inhibitors during rescue PCI. We recently reported that abciximab treatment during rescue PCI has a beneficial effect on the short-term prognosis, without excess bleeding complications. This result can be achieved by using the radial approach, a low-dose weight-adjusted heparin regimen, and by limiting the use of aortic counterpulsation. In conclusion, in case of thrombolysis failure, patients should be referred to tertiary hospitals where rescue PCI can be performed with expertise.
authors.affiliation: Cardio Thoracic Department, University of Pisa, Pisa, Italy. a.petronio@mail.ao-pisa.toscana.it
authors.forename: Anna Sonia
authors.initials: AS
authors.lastname: Petronio
authors.forename: Marco
authors.initials: M
authors.lastname: De Carlo
authors.forename: Roberta
authors.initials: R
authors.lastname: Rossini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Amoroso
authors.forename: Ugo
authors.initials: U
authors.lastname: Limbruno
authors.forename: Nicola
authors.initials: N
authors.lastname: Ciabatti
authors.forename: Caterina
authors.initials: C
authors.lastname: Palagi
authors.forename: Paolo
authors.initials: P
authors.lastname: Caravelli
authors.forename: Mario
authors.initials: M
authors.lastname: Mariani
mesh_terms: D015906:Angioplasty, Balloon, Coronary; D003131:Combined Modality Therapy; D006801:Humans; D009203:Myocardial Infarction / Q000628:therapy*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000009:adverse effects / Q000627:therapeutic use*; D019106:Postoperative Hemorrhage / Q000139:chemically induced
chemical_list: D019039:Platelet Glycoprotein GPIIb-IIIa Complex