title: The role of Glycoprotein IIb/IIIa inhibitors in acute coronary syndromes and the interference with anemia.
abstract: The role played by glycoprotein (GP) IIb/IIIa inhibitors (GPI) has continuously evolved until the most recent Guidelines whereby they were stepped down from class I to class II recommendation for treating acute coronary syndromes (ACS). GPI compete with a wider use of ADP inhibitors and novel anticoagulant drugs although GPI use has greatly narrowed. However, GPI may still have a role. Several criteria were proposed to define post-PCI anemia which is strictly related to bleeding and transfusion. In ACS, it should be important to define anemia in comparative terms versus baseline levels: ≥ 15% of red blood cell decrease should be a practical cut-off value. If one wishes to concentrate on hemoglobin (Hb), a≥2g/dl Hb decrease from baseline should be considered. It is important to recognize post-PCI anemia in the setting of ACS. There are sub-populations exposed to short-term hemorrhagic and/or long-term ischemic risks. Ischemic and hemorrhagic risks need to be carefully evaluated along with thrombocytopenia and its prognostic significance in order to put all these blood and rheological parameters into a clinically oriented perspective on which therapeutical decisions should be based. Definition of high risk procedures (complexity, angiographic characteristics and patient's risk profile, regardless whether STEMI or NSTEMI) may help selecting GPI. There are positive elements in GPI use: efficacy, rapid onset and reversibility of action, absence of pharmacogenomic variability, pharmacoeconomic considerations and the possibility of intracoronary administration. All these elements should be evaluated when selecting these agents for therapeutics.
authors: Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Italy. Electronic address: paoloemilio.puddu@uniroma1.it.
authors: Paolo Emilio
authors: PE
authors: Puddu
authors: Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Italy. Electronic address: iannettaloredana@libero.it.
authors: Loredana
authors: L
authors: Iannetta
authors: Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Italy. Electronic address: attilioplacanica@alice.it.
authors: Attilio
authors: A
authors: Placanica
authors: Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Italy. Electronic address: domenico.cuturello@uniroma1.it.
authors: Domenico
authors: D
authors: Cuturello
authors: Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza University of Rome, Italy. Electronic address: michele.schiariti@uniroma1.it.
authors: Michele
authors: M
authors: Schiariti
authors: Department of Specialistic, Diagnostic and Experimental Medicine (DIMES), Alma Mater University, Bologna, Italy. Electronic address: olivia.manfrini@unibo.it.
authors: Olivia
authors: O
authors: Manfrini
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000188:drug therapy*; D000740:Anemia / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex
keywords: Acute coronary syndromes; Acute ischemia; Elderly, anemia; GP IIb/IIIa inhibitors; High risk patients; PCI