title: The evolving role of glycoprotein IIb/IIIa inhibitors in the setting of percutaneous coronary intervention strategies to minimize bleeding risk and optimize outcomes.
abstract: The use of glycoprotein IIb/IIIa inhibitors (GPI) reduces ischemic events in patients undergoing percutaneous coronary intervention (PCI). However, the same properties that confer this benefit lead to an increased bleeding risk. Recent studies have shown a less robust net clinical benefit of GPI in the current era of routine thienopyridine and direct thrombin inhibitor use. To optimize the net clinical benefit of GPI, these agents need to be selectively used in patients most likely to benefit from their anti-ischemic effect, namely patients undergoing PCI for non-ST-segment elevation myocardial infarction, select patients undergoing primary PCI, and select patients undergoing PCI without appropriate pre-loading with a thienopyridine. Moreover, strategies to minimize bleeding should be applied in these patients and include shorter GPI infusions (in some patients), dose adjustments of heparin and GPI, careful access site management with more frequent use of the transradial approach, use of smaller sheaths, and identification of patients at high bleeding risk. This review provides an update of the current literature that supports these measures, an insight on the tailored use of GPI, and a potential direction for future research addressing combined antithrombotic therapies.
authors.affiliation: Department of Medicine, Cardiovascular Section, Louisiana State University, 1542 Tulane Avenue, New Orleans, LA 70112, USA. ehanna10@yahoo.com
authors.forename: Elias B
authors.initials: EB
authors.lastname: Hanna
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Rao
authors.forename: Steven V
authors.initials: SV
authors.lastname: Manoukian
authors.forename: Jorge F
authors.initials: JF
authors.lastname: Saucedo
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy / Q000628:therapy*; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation / Q000379:methods*; D000925:Anticoagulants / Q000627:therapeutic use; D000991:Antithrombins / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000188:drug therapy / Q000628:therapy*; D000077542:Eptifibatide; D006470:Hemorrhage / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D006629:Hirudins; D006801:Humans; D010446:Peptide Fragments / Q000627:therapeutic use; D010455:Peptides / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011994:Recombinant Proteins / Q000627:therapeutic use; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D000991:Antithrombins; D006629:Hirudins; D010446:Peptide Fragments; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011994:Recombinant Proteins; D000077542:Eptifibatide; C074619:bivalirudin