Real-world safety and efficacy of glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention.
BACKGROUND
Large randomized clinical trials have demonstrated differences in the efficacy and safety of glycoprotein (GP) IIb/IIIa inhibitors, but little has been published regarding comparisons of these agents in a "real-world" setting.


OBJECTIVE
This study evaluated the safety and efficacy of GP IIb/IIIa inhibitors in a large population of patients who underwent percutaneous coronary intervention (PCI) during a 5-year period.


METHODS
Patients undergoing PCI from 2000 through 2004 were eligible for inclusion if they received any single GP IIb/IIIa inhibitor. Patients with significant comorbidities were included. Patients were excluded if they received more than one GP IIb/IIIa inhibitor or underwent catheterization without PCI. Target activated clotting time was 200-250 seconds.


RESULTS
Of 5,055 patients undergoing PCI, 4,321 (85%) received a single GP IIb/IIIa inhibitor (abciximab, 1,178; eptifibatide, 1,698; tirofiban, 1,445). Major bleeding complications were rare, ranging from 1.9-3.1%, and transfusion rates were low, ranging from 0.8-2.1%, with no significant differences among the agents evaluated. No significant differences in 1-year mortality, myocardial infarction, urgent target vessel revascularization or composite endpoint rates were identified among the therapeutic agents.


CONCLUSIONS
In this large study of PCI patients, GP IIb/IIIa inhibition was associated with a low incidence of major bleeding complications and requirement of transfusion. With appropriate management, GP IIb/IIIa inhibitor use can benefit patients undergoing PCI, with minimal risk of bleeding complications.
Casterella
Peter J
PJ
Utah Heart Clinic and LDS Hospital, 324 Tenth Avenue, Suite 206, Salt Lake City, UT, 84143, USA. pcasterella@aol.com
Revenaugh
James R
JR
Burke
James L
JL
Pearson
Robert R
RR
Bair
Tami L
TL
May
Heidi T
HT
Horne
Benjamin
B
Anderson
Jeffrey L
JL
Muhlestein
Joseph B
JB
D000077284:Abciximab; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000009:adverse effects / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000628:therapy*; D000077542:Eptifibatide; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000009:adverse effects / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D012189:Retrospective Studies; D000077466:Tirofiban; D014443:Tyrosine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; D000077466:Tirofiban; D000077542:Eptifibatide; D000077284:Abciximab