The evolving role of glycoprotein IIb/IIIa inhibitor therapy in contemporary care of acute coronary syndrome patients.

Results from clinical trials of glycoprotein IIb/IIIa(GPIIb/IIIa) inhibitors during the past decade have established their current role in the treatment of non-ST-segment elevation acute coronary syndrome and in percutaneous coronary interventions. However, there are still unanswered questions on optimal use of GPIIb/IIIa inhibitors. Moreover, as new concomitant or alternative medications become available, the role of GPIIb/IIIa inhibitors must be reconsidered. This review discusses, in the light of clinical trials recently presented, what we know, what we are learning, and what we still need to learn.

[1]  Eric Peterson,et al.  Correlates of bleeding events among moderate- to high-risk patients undergoing percutaneous coronary intervention and treated with eptifibatide: observations from the PROTECT-TIMI-30 trial. , 2006, Journal of the American College of Cardiology.

[2]  A. Kastrati,et al.  Abciximab in patients with acute coronary syndromes undergoing percutaneous coronary intervention after clopidogrel pretreatment: the ISAR-REACT 2 randomized trial. , 2006, JAMA.

[3]  Peter C Gøtzsche,et al.  Lessons from and cautions about noninferiority and equivalence randomized trials. , 2006, JAMA.

[4]  K. Alexander,et al.  Excess dosing of antiplatelet and antithrombin agents in the treatment of non-ST-segment elevation acute coronary syndromes. , 2005, JAMA.

[5]  R. Califf,et al.  The early glycoprotein IIb/IIIa inhibition in non-ST-segment elevation acute coronary syndrome (EARLY ACS) trial: a randomized placebo-controlled trial evaluating the clinical benefits of early front-loaded eptifibatide in the treatment of patients with non-ST-segment elevation acute coronary syndro , 2005, American heart journal.

[6]  W. Gibler,et al.  Early glycoprotein IIb/IIIa inhibitor use for non-ST-segment elevation acute coronary syndrome: patient selection and associated treatment patterns. , 2005, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[7]  Sue-Jane Wang,et al.  A Regulatory Perspective on Choice of Margin and Statistical Inference Issue in Non‐inferiority Trials , 2005, Biometrical journal. Biometrische Zeitschrift.

[8]  G. Keating,et al.  Bivalirudin: a review of its use in patients undergoing percutaneous coronary intervention. , 2005, Drugs.

[9]  H. White,et al.  Acute Catheterization and Urgent Intervention Triage strategY (ACUITY) trial: study design and rationale. , 2004, American heart journal.

[10]  E. Braunwald,et al.  Association between duration of tirofiban therapy before percutaneous intervention and tissue level perfusion (a TACTICS-TIMI 18 substudy). , 2004, The American journal of cardiology.

[11]  A. Kastrati,et al.  A clinical trial of abciximab in elective percutaneous coronary intervention after pretreatment with clopidogrel. , 2004, The New England journal of medicine.

[12]  E. Peterson,et al.  Early use of glycoprotein IIb/IIIa inhibitors in non-ST-elevation acute myocardial infarction: observations from the National Registry of Myocardial Infarction 4. , 2003, Journal of the American College of Cardiology.

[13]  E. Topol,et al.  Bivalirudin and provisional glycoprotein IIb/IIIa blockade compared with heparin and planned glycoprotein IIb/IIIa blockade during percutaneous coronary intervention: REPLACE-2 randomized trial. , 2003, JAMA.

[14]  J. Ioannidis,et al.  Intravenous glycoprotein IIb/IIIa receptor antagonists reduce mortality after percutaneous coronary interventions. , 2003, Journal of the American College of Cardiology.

[15]  Carl J Pepine,et al.  ACC/AHA guideline update for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction--2002: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients , 2002, Circulation.

[16]  E. Antman,et al.  An integrated clinical approach to predicting the benefit of tirofiban in non-ST elevation acute coronary syndromes. Application of the TIMI Risk Score for UA/NSTEMI in PRISM-PLUS. , 2002, European heart journal.

[17]  R. Califf,et al.  Platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: a meta-analysis of all major randomised clinical trials , 2002, The Lancet.

[18]  S. Yusuf,et al.  Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. , 2001, The New England journal of medicine.

[19]  V. Hasselblad,et al.  Benefit of Glycoprotein IIb/IIIa Inhibition in Patients With Acute Coronary Syndromes and Troponin T–Positive Status: The PARAGON-B Troponin T Substudy , 2001, Circulation.

[20]  M. Simoons.  Effect of glycoprotein IIb/IIIa receptor blocker abciximab on outcome in patients with acute coronary syndromes without early coronary revascularisation: the GUSTO IV-ACS randomised trial , 2001, The Lancet.

[21]  H. White,et al.  Troponin concentrations for stratification of patients with acute coronary syndromes in relation to therapeutic efficacy of tirofiban , 1999, The Lancet.

[22]  R. Califf,et al.  Platelet glycoprotein IIb/IIIa receptor inhibition in non-ST-elevation acute coronary syndromes: early benefit during medical treatment only, with additional protection during percutaneous coronary intervention. , 1999, Circulation.

[23]  S. Snapinn,et al.  Intracoronary thrombus and platelet glycoprotein IIb/IIIa receptor blockade with tirofiban in unstable angina or non-Q-wave myocardial infarction. Angiographic results from the PRISM-PLUS trial (Platelet receptor inhibition for ischemic syndrome management in patients limited by unstable signs and s , 1999, Circulation.

[24]  C. Heeschen,et al.  Angiographic findings in patients with refractory unstable angina according to troponin T status. , 1999, Circulation.

[25]  E. Braunwald,et al.  Unstable angina: an etiologic approach to management. , 1998, Circulation.

[26]  T. Investigators.  Randomised placebo-controlled and balloon-angioplasty-controlled trial to assess safety of coronary stenting with use of platelet glycoprotein-IIb/IIIa blockade. , 1998, Lancet.

[27]  Gebhardt,et al.  International, randomized, controlled trial of lamifiban (a platelet glycoprotein IIb/IIIa inhibitor), heparin, or both in unstable angina , 1998 .

[28]  Epilog Investigators,et al.  Platelet glycoprotein IIb/IIIa receptor blockade and low-dose heparin during percutaneous coronary revascularization. , 1997, The New England journal of medicine.

[29]  Epic Investigators,et al.  Use of a monoclonal antibody directed against the platelet glycoprotein IIb/IIIa receptor in high-risk coronary angioplasty. , 1994, The New England journal of medicine.

[30]  L. Harker,et al.  Role of platelets and thrombosis in mechanisms of acute occlusion and restenosis after angioplasty. , 1987, The American journal of cardiology.