Intravenous glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: lessons from recently conducted randomized clinical trials.
The opportunity to completely inhibit platelet aggregation via the glycoprotein (GP)IIb/IIIa receptor represents a major innovation in antiplatelet therapy. Numerous trials conducted during the 1990s in patients undergoing percutaneous coronary intervention established GPIIb/IIIa inhibitors as a valuable component of treatment. Phase II trials in the medical management of acute coronary syndrome (ACS) patients also suggested beneficial effects, which encouraged six major phase III clinical trials to be conducted. In general, cardiac complications were reduced in those ACS patients who were not routinely scheduled for early revascularization. However, the treatment effect in the average patient is modest and overall 100 patients need to be treated in order to prevent one death or myocardial infarction. Given the current attention to healthcare costs, these agents may therefore be reserved for patients at suspected high risk of death or (re)infarction, including patients with diabetes mellitus and elevated cardiac troponins.
Boersma
Eric
E
Clinical Epidemiology Unit, Department of Cardiology, Room H543, Erasmus MC, Dr Molewaterplein 40, 3015 GD Rotterdam, The Netherlands. h.boersma@erasmusmc.nl
Westerhout
Cynthia M
CM
D000077284:Abciximab; D000085:Acetates / Q000627:therapeutic use; D000208:Acute Disease; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D003327:Coronary Disease / Q000378:metabolism / Q000628:therapy*; D000077542:Eptifibatide; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D007275:Injections, Intravenous; D010455:Peptides / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D016032:Randomized Controlled Trials as Topic; D000077466:Tirofiban; D014443:Tyrosine / Q000031:analogs & derivatives* / 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