[Effectiveness and safety of triple antiaggregation in patients undergoing coronary intervention].
OBJECTIVE
To evaluate glycoprotein IIb/IIIa inhibitors (GPIIb/IIIa inhibitors) effectiveness and safety in patients with non-ST segment elevation acute coronary syndrome (NSTEACS) or stable coronary disease referred for percutaneous coronary revascularization pre-treated with aspirin and thienopyridines by means of a systematic review.


METHODS
Electronic search using Medline, Embase, Pascal, Cochrane Library and ISI Proceedings and manual review of the articles found.


METHODS
We included randomized controlled trials that assessed the clinical efficacy (risk of death or infarction) and safety (bleeding and thrombocytopenia) of GPIIb/IIIa inhibitors in patients pretreated with thienopyridines.


METHODS
Data were obtained by duplicate.


RESULTS
Nine randomized controlled trials (8,604 patients) were included. Addition of GPIIb/ IIIa inhibitors reduced the risk of death or myo-cardial infarction at 30 days in those trials that included patients with NSTEACS (RR 0.67; 95%CI 0.56-0.80) but not in studies that excluded NSTEACS patients (RR 1.07; 95%CI 0.75-1.53) (p test of interaction 0.0175), As a counterpart, GPIIb/ IIIa inhibitors increased the risk of bleeding and thrombocytopenia.


CONCLUSIONS
Use of GPIIb/IIIa inhibitors reduces the risk of adverse cardiac events in NSTEACS patients pre-treated with aspirin and thienopyridines but increases the risk of severe bleeding and thrombocytopenia. Its utilization in stable coronary patients does not seem justified.
Latour-Pérez
J
J
Servicio de Medicina Intensiva, Hospital General de Elche, Alicante. jlatour@coma.es
de Miguel-Balsa
E
E
Alcalá-López
A
A
Coves-Orts
F J
FJ
D015906:Angioplasty, Balloon, Coronary; D002986:Clinical Trials as Topic; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D012449:Safety
D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex