A randomized trial assessing the impact of three different glycoprotein IIb/IIIa antagonists on glycoprotein IIb/IIIa platelet receptor inhibition and clinical endpoints in patients with acute coronary syndromes.
OBJECTIVE
To compare three glycoprotein IIb/IIIa receptor antagonists (GPIs) in terms of platelet inhibition and major adverse cardiac events (MACEs), and assess the rate of bleeding and MACEs between GPIs and coadministered P2Y12 agents.


METHODS
Eighty-three acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) with planned GPI use were randomized to receive high-dose bolus tirofiban, double-bolus eptifibatide, or abciximab followed by a 12-hour infusion. Glycoprotein IIb/IIIa platelet receptor inhibition was measured at baseline and at 10 minutes, 1 hour, and 24 hours postbolus dose. Major adverse cardiac events and bleeding complications at 30 days were documented. The incidence of MACEs and bleeding in patients receiving ticagrelor or prasugrel were compared to those given clopidogrel.


RESULTS
There were no statistically significant differences in platelet inhibition between GPIs at 10 minutes (P=.085) and 1 hour (P=.337). At 24 hours, abciximab achieved statistically significantly higher median [interquartile range] platelet inhibition (75 [65-88]%) compared to tirofiban (28 [3-56]%; P<.0001) and eptifibatide (44 [31-63]%; P=.007). There were no differences in bleeding or MACEs depending on GPI or P2Y12 inhibitor administered.


CONCLUSIONS
Glycoprotein receptor inhibitors achieve similar levels of platelet inhibition at 10 minutes and 1 hour; however, abciximab maintains this benefit 24 hours after bolus dose. We did not witness an increased rate of bleeding in patients given new potent P2Y12 inhibitors and a GPI in the modern era.
South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia.|Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia.
Lewis E
LE
Holmes
South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia.|Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia.
Rohan
R
Gupta
South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia.|Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia.
Saissan
S
Rajendran
South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia.|Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia.
John
J
Luu
South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia.|Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia.
John K
JK
French
South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia. c.juergens@unsw.edu.au.|Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia. c.juergens@unsw.edu.au.
Craig P
CP
Juergens
D000077284:Abciximab; D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D000241:Adenosine / Q000008:administration & dosage / Q000031:analogs & derivatives; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000009:adverse effects; D001792:Blood Platelets / Q000187:drug effects* / Q000378:metabolism; D000077144:Clopidogrel; D004359:Drug Therapy, Combination; D000077542:Eptifibatide; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D010455:Peptides / Q000008:administration & dosage* / Q000009:adverse effects; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D010979:Platelet Function Tests; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors* / Q000378:metabolism; D000068799:Prasugrel Hydrochloride / Q000008:administration & dosage; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage; D058925:Receptors, Purinergic P2Y12 / Q000097:blood / Q000187:drug effects; D012307:Risk Factors; D000077486:Ticagrelor; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D013997:Time Factors; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; C548576:P2RY12 protein, human; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D058921:Purinergic P2Y Receptor Antagonists; D058925:Receptors, Purinergic P2Y12; D014443:Tyrosine; D000077144:Clopidogrel; D000068799:Prasugrel Hydrochloride; D000077466:Tirofiban; D000077486:Ticagrelor; D000241:Adenosine; D000077542:Eptifibatide; D013988:Ticlopidine; D000077284:Abciximab
Abciximab; Acute coronary syndrome; Eptifibatide; Glycoprotein IIbIIIa antagonist; Percutaneous coronary intervention; Tirofiban