Cardiovascular Revascularization Medicine
Volume 8, Issue 4 , Pages 281-288 , October 2007

Glycoprotein IIb/IIIa inhibitors: questioning indications and treatment algorithms

  • Edo Kaluski

      Affiliations

    • Department of Cardiology, University Medical Center, University of Medicine and Dentistry, Newark, NJ, USA
    • Corresponding Author InformationCorresponding author. Invasive Cardiology and Cardiac Catheterization Laboratories, University Hospital, University of Medicine and Dentistry of New Jersey, 185 South Orange Avenue, MSB I-538, Newark, NJ 07101, USA. Tel.: +1 973 972 4731, +1 973 7382603 (cellular); fax: +1 973 972 1592.
    • ,
  • Bunyad Haider

      Affiliations

    • Department of Medicine, University Medical Center, University of Medicine and Dentistry, Newark, NJ, USA
    • ,
  • Olga Milo-Cotter

      Affiliations

    • Duke Cardiology Research Institute, Durham, NC, USA
    • ,
  • Marc Klapholz

      Affiliations

    • Department of Cardiology, University Medical Center, University of Medicine and Dentistry, Newark, NJ, USA

Received 30 March 2007 ,Accepted 30 March 2007.

References 

  1. Silber S, Albertsson P, Aviles FF, Camici PG, Colombo A, Hamm C, et al. Percutaneous coronary interventions. Guidelines of the European Society of Cardiology—ESC. Kardiol Pol. 2005;63:265–320[discussion 321–263]
  2. Bertrand OF, De Larochelliere R, Rodes-Cabau J, Proulx G, Gleeton O, Nguyen CM, et al. A randomized study comparing same-day home discharge and abciximab bolus only to overnight hospitalization and abciximab bolus and infusion after transradial coronary stent implantation. Circulation. 2006;114:2636–2643
  3. Kong DF, Hasselblad V, Harrington RA, White HD, Tcheng JE, Kandzari DE, et al. Meta-analysis of survival with platelet glycoprotein IIb/IIIa antagonists for percutaneous coronary interventions. Am J Cardiol. 2003;92:651–655
  4. Brown DL, Fann CS, Chang CJ. Meta-analysis of effectiveness and safety of abciximab versus eptifibatide or tirofiban in percutaneous coronary intervention. Am J Cardiol. 2001;87:537–541
  5. Karvouni E, Katritsis DG, Ioannidis JP. Intravenous glycoprotein IIb/IIIa receptor antagonists reduce mortality after percutaneous coronary interventions. J Am Coll Cardiol. 2003;41:26–32
  6. Anderson KM, Califf RM, Stone GW, Neumann FJ, Montalescot G, Miller DP, et al. Long-term mortality benefit with abciximab in patients undergoing percutaneous coronary intervention. J Am Coll Cardiol. 2001;37:2059–2065
  7. Lefkovits J, Blankenship JC, Anderson KM, Stoner GL, Talley JD, Worley SJ, et al. Increased risk of non-Q wave myocardial infarction after directional atherectomy is platelet dependent: evidence from the EPIC trial. Evaluation of c7e3 for the prevention of ischemic complications. J Am Coll Cardiol. 1996;28:849–855
  8. Stone GW, Grines CL, Cox DA, Garcia E, Tcheng JE, Griffin JJ, et al. Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction. N Engl J Med. 2002;346:957–966
  9. Eisenberg MJ, Jamal S. Glycoprotein IIb/IIIa inhibition in the setting of acute ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2003;42:1–6
  10. Boersma E, Harrington RA, Moliterno DJ, White H, Theroux P, Van de Werf F, et al. Platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: a meta-analysis of all major randomised clinical trials. Lancet. 2002;359:189–198
  11. Bromberg-Marin G, Marin-Neto JA, Parsons LS, Canto JG, Rogers WJ. Effectiveness and safety of glycoprotein IIb/IIIa inhibitors and clopidogrel alone and in combination in non-ST-segment elevation myocardial infarction (from the National Registry of Myocardial Infarction-4). Am J Cardiol. 2006;98:1125–1131
  12. Newby LK, Califf RM, White HD, Harrington RA, Van de Werf F, Granger CB, et al. The failure of orally administered glycoprotein IIb/IIIa inhibitors to prevent recurrent cardiac events. Am J Med. 2002;112:647–658
  13. Chew DP, Bhatt DL, Sapp S, Topol EJ. Increased mortality with oral platelet glycoprotein IIb/IIIa antagonists: a meta-analysis of phase III multicenter randomized trials. Circulation. 2001;103:201–206
  14. Bonz AW, Lengenfelder B, Strotmann J, Held S, Turschner O, Harre K, et al. Effect of additional temporary glycoprotein IIb/IIIa receptor inhibition on troponin release in elective percutaneous coronary interventions after pretreatment with aspirin and clopidogrel (TOPSTAR trial). J Am Coll Cardiol. 2002;40:662–668
  15. Segev A, Goldman LE, Cantor WJ, Barr A, Strauss BH, Winegard LD, et al. Elevated troponin-I after percutaneous coronary interventions: incidence and risk factors. Cardiovasc Radiat Med. 2004;5:59–63
  16. Milkovich G, Gibson G. Economic impact of bleeding complications and the role of antithrombotic therapies in percutaneous coronary intervention. Am J Health Syst Pharm. 2003;60:S15–S21
  17. Mehta SR, Steg PG, Granger CB, Bassand JP, Faxon DP, Weitz JI, et al. Randomized, blinded trial comparing fondaparinux with unfractionated heparin in patients undergoing contemporary percutaneous coronary intervention: Arixtra Study in Percutaneous Coronary Intervention: A Randomized Evaluation (ASPIRE) pilot trial. Circulation. 2005;111:1390–1397
  18. Stone GW, McLaurin BT, Cox DA, Bertrand ME, Lincoff AM, Moses JW, et al. Bivalirudin for patients with acute coronary syndromes. N Engl J Med. 2006;355:2203–2216
  19. Lincoff AM, Bittl JA, Harrington RA, Feit F, Kleiman NS, Jackman JD, 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. JAMA. 2003;289:853–863
  20. Montalescot G, White HD, Gallo R, Cohen M, Steg PG, Aylward PE, et al. Enoxaparin versus unfractionated heparin in elective percutaneous coronary intervention. N Engl J Med. 2006;355:1006–1017
  21. Horwitz PA, Berlin JA, Sauer WH, Laskey WK, Krone RJ, Kimmel SE. Bleeding risk of platelet glycoprotein IIb/IIIa receptor antagonists in broad-based practice (results from the Society for Cardiac Angiography and Interventions Registry). Am J Cardiol. 2003;91:803–806
  22. Ellis SG, Bhatt D, Kapadia S, Lee D, Yen M, Whitlow PL. Correlates and outcomes of retroperitoneal hemorrhage complicating percutaneous coronary intervention. Catheter Cardiovasc Interv. 2006;67:541–545
  23. Mahaffey KW, Harrington RA, Simoons ML, Granger CB, Graffagnino C, Alberts MJ, et al. Stroke in patients with acute coronary syndromes: incidence and outcomes in the platelet glycoprotein IIb/IIIa in unstable angina. Receptor suppression using integrilin therapy (PURSUIT) trial. The PURSUIT Investigators. Circulation. 1999;99:2371–2377
  24. Sadeghi HM, Grines CL, Chandra HR, Dixon SR, Boura JA, Dukkipati S, et al. Percutaneous coronary interventions in octogenarians. Glycoprotein IIb/IIIa receptor inhibitors' safety profile. J Am Coll Cardiol. 2003;42:428–432
  25. Berger PB, Best PJ, Topol EJ, White J, DiBattiste PM, Chan AW, et al. The relation of renal function to ischemic and bleeding outcomes with 2 different glycoprotein IIb/IIIa inhibitors: the do Tirofiban and ReoPro Give Similar Efficacy Outcome (TARGET) trial. Am Heart J. 2005;149:869–875
  26. Attallah N, Yassine L, Fisher K, Yee J. Risk of bleeding and restenosis among chronic kidney disease patients undergoing percutaneous coronary intervention. Clin Nephrol. 2005;64:412–418
  27. Alexander KP, Chen AY, Roe MT, Newby LK, Gibson CM, Allen-LaPointe NM, et al. Excess dosing of antiplatelet and antithrombin agents in the treatment of non-ST-segment elevation acute coronary syndromes. JAMA. 2005;294:3108–3116
  28. Konstance R, Tcheng JE, Wightman MB, Kelly LP, Moore A, Harrison JK, et al. Incidence and predictors of major vascular complications after percutaneous coronary intervention in the glycoprotein IIb/IIIa platelet inhibitor era. J Interv Cardiol. 2004;17:65–70
  29. Piper WD, Malenka DJ, Ryan TJ, Shubrooks SJ, O'Connor GT, Robb JF, et al. Predicting vascular complications in percutaneous coronary interventions. Am Heart J. 2003;145:1022–1029
  30. Nikolsky E, Mehran R, Halkin A, Aymong ED, Mintz GS, Lasic Z, et al. Vascular complications associated with arteriotomy closure devices in patients undergoing percutaneous coronary procedures: a meta-analysis. J Am Coll Cardiol. 2004;44:1200–1209
  31. Hochtl T, Pachinger L, Unger G, Geppert A, Wojta J, Harenberg J, et al. Antiplatelet drug induced isolated profound thrombocytopenia in interventional cardiology: a review based on individual case reports. J Thromb Thrombolysis. 2007;
  32. Rosove MH. Platelet glycoprotein IIb/IIIa inhibitors. Best Pract Res. 2004;17:65–76
  33. Dasgupta H, Blankenship JC, Wood GC, Frey CM, Demko SL, Menapace FJ. Thrombocytopenia complicating treatment with intravenous glycoprotein IIb/IIIa receptor inhibitors: a pooled analysis. Am Heart J. 2000;140:206–211
  34. Tcheng JE, Kereiakes DJ, Lincoff AM, George BS, Kleiman NS, Sane DC, et al. Abciximab readministration: results of the ReoPro readministration registry. Circulation. 2001;104:870–875
  35. Kaluski E, Leitman M, Khiger I, Cotter G. Delayed thrombocytopenia following abciximab therapy. Int J Cardiovasc Intervent. 2001;4:151–155
  36. Kereiakes DJ, Berkowitz SD, Lincoff AM, Tcheng JE, Wolski K, Achenbach R, et al. Clinical correlates and course of thrombocytopenia during percutaneous coronary intervention in the era of abciximab platelet glycoprotein IIb/IIIa blockade. Am Heart J. 2000;140:74–80
  37. Nikolsky E, Sadeghi HM, Effron MB, Mehran R, Lansky AJ, Na Y, et al. Impact of in-hospital acquired thrombocytopenia in patients undergoing primary angioplasty for acute myocardial infarction. Am J Cardiol. 2005;96:474–481
  38. Scirica BM, Cannon CP, Cooper R, Aster RH, Brassard J, McCabe CH, et al. Drug-induced thrombocytopenia and thrombosis: evidence from patients receiving an oral glycoprotein IIb/IIIa inhibitor in the orbofiban in patients with unstable coronary syndromes (OPUS-TIMI 16) trial. J Thromb Thrombolysis. 2006;22:95–102
  39. Weintraub WS, Thompson TD, Culler S, Boccuzzi SJ, Becker ER, Kosinski AS, et al. Targeting patients undergoing angioplasty for thrombus inhibition: a cost-effectiveness and decision support model. Circulation. 2000;102:392–398
  40. Robinson M, Ginnelly L, Sculpher M, Jones L, Riemsma R, Palmer S, et al. A systematic review update of the clinical effectiveness and cost-effectiveness of glycoprotein IIb/IIIa antagonists. Health Technol Assess. 2002;6:1–160
  41. Hillegass WB, Newman AR, Raco DL. Glycoprotein IIb/IIIa receptor therapy in percutaneous coronary intervention and non-ST-segment elevation acute coronary syndromes. Estimating the economic implications. Pharmacoeconomics. 2001;19:41–55
  42. Zwart-van Rijkom JE, van Hout BA. Cost-efficacy in interventional cardiology; results from the EPISTENT study. Evaluation of Platelet IIb/IIIa Inhibitor for Stenting Trial. Eur Heart J. 2001;22:1476–1484
  43. Cohen DJ, Lincoff AM, Lavelle TA, Chen HL, Bakhai A, Berezin RH, et al. Economic evaluation of bivalirudin with provisional glycoprotein IIb/IIIa inhibition versus heparin with routine glycoprotein IIb/IIIa inhibition for percutaneous coronary intervention: results from the REPLACE-2 trial. J Am Coll Cardiol. 2004;44:1792–1800
  44. Mishkel GJ, Moore AL, Markwell SJ, Ligon RW. Bivalirudin versus heparin plus glycoprotein IIb/IIIa inhibitors in drug-eluting stent implantations in the absence of acute myocardial infarction: clinical and economic results. J Invasive Cardiol. 2007;19:63–68
  45. Borg S, Persson U, Allikmets K, Ericsson K. Comparative cost-effectiveness of anticoagulation with bivalirudin or heparin with and without a glycoprotein IIb/IIIa-receptor inhibitor in patients undergoing percutaneous coronary intervention in Sweden: a decision-analytic model. Clin Ther. 2006;28:1947–1959
  46. Sabatine MS, Januzzi JL, Snapinn S, Theroux P, Jang IK. A risk score system for predicting adverse outcomes and magnitude of benefit with glycoprotein IIb/IIIa inhibitor therapy in patients with unstable angina pectoris. Am J Cardiol. 2001;88:488–492
  47. Huang R, Sacks J, Thai H, Goldman S, Morrison DA, Barbiere C, et al. Impact of stents and abciximab on survival from cardiogenic shock treated with percutaneous coronary intervention. Catheter Cardiovasc Interv. 2005;65:25–33
  48. Cura FA, Bhatt DL, Lincoff AM, Kapadia SR, L'Allier PL, Ziada KM, et al. Pronounced benefit of coronary stenting and adjunctive platelet glycoprotein IIb/IIIa inhibition in complex atherosclerotic lesions. Circulation. 2000;102:28–34
  49. Colwell JA. Antiplatelet agents for the prevention of cardiovascular disease in diabetes mellitus. Am J Cardiovasc Drugs. 2004;4:87–106
  50. Marso SP, Lincoff AM, Ellis SG, Bhatt DL, Tanguay JF, Kleiman NS, et al. Optimizing the percutaneous interventional outcomes for patients with diabetes mellitus: results of the EPISTENT (Evaluation of Platelet IIb/IIIa Inhibitor for Stenting Trial) diabetic substudy. Circulation. 1999;100:2477–2484
  51. Roffi M, Chew DP, Mukherjee D, Bhatt DL, White JA, Heeschen C, et al. Platelet glycoprotein IIb/IIIa inhibitors reduce mortality in diabetic patients with non-ST-segment-elevation acute coronary syndromes. Circulation. 2001;104:2767–2771
  52. Cho L, Topol EJ, Balog C, Foody JM, Booth JE, Cabot C, et al. Clinical benefit of glycoprotein IIb/IIIa blockade with abciximab is independent of gender: pooled analysis from EPIC, EPILOG and EPISTENT trials. Evaluation of 7e3 for the Prevention of Ischemic Complications. Evaluation in Percutaneous Transluminal Coronary Angioplasty to Improve Long-Term Outcome with Abciximab GP IIb/IIIa Blockade. Evaluation of Platelet IIb/IIIa Inhibitor for Stent. J Am Coll Cardiol. 2000;36:381–386
  53. Roffi M, Mukherjee D, Chew DP, Bhatt DL, Cho L, Robbins MA, et al. Lack of benefit from intravenous platelet glycoprotein IIb/IIIa receptor inhibition as adjunctive treatment for percutaneous interventions of aortocoronary bypass grafts: a pooled analysis of five randomized clinical trials. Circulation. 2002;106:3063–3067
  54. Karha J, Gurm HS, Rajagopal V, Fathi R, Bavry AA, Brener SJ, et al. Use of platelet glycoprotein IIb/IIIa inhibitors in saphenous vein graft percutaneous coronary intervention and clinical outcomes. Am J Cardiol. 2006;98:906–910
  55. Berger JS, Slater JN, Sherman W, Green SJ, Sanborn TA, Brown DL. Impact of platelet glycoprotein IIb/IIIa inhibitor therapy on in-hospital outcomes and long-term survival following percutaneous coronary rotational atherectomy. J Thromb Thrombolysis. 2005;19:47–54
  56. Mehta SR, Yusuf S, Peters RJ, Bertrand ME, Lewis BS, Natarajan MK, et al. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet. 2001;358:527–533
  57. Chan AW, Moliterno DJ, Berger PB, Stone GW, DiBattiste PM, Yakubov SL, et al. Triple antiplatelet therapy during percutaneous coronary intervention is associated with improved outcomes including one-year survival: results from the do Tirofiban and ReoPro Give Similar Efficacy Outcome Trial (TARGET). J Am Coll Cardiol. 2003;42:1188–1195
  58. Kastrati A, Mehilli J, Schuhlen H, Dirschinger J, Dotzer F, ten Berg JM, et al. A clinical trial of abciximab in elective percutaneous coronary intervention after pretreatment with clopidogrel. N Engl J Med. 2004;350:232–238
  59. Kastrati A, Mehilli J, Neumann FJ, Dotzer F, ten Berg J, Bollwein H, et al. Abciximab in patients with acute coronary syndromes undergoing percutaneous coronary intervention after clopidogrel pretreatment: the ISAR-REACT 2 randomized trial. JAMA. 2006;295:1531–1538
  60. Harjai KJ, Stone GW, Grines CL, Cox DA, Garcia E, Tcheng JE, et al. Usefulness of routine unfractionated heparin infusion following primary percutaneous coronary intervention for acute myocardial infarction in patients not receiving glycoprotein IIb/IIIa inhibitors. Am J Cardiol. 2007;99:202–207
  61. Stone GW, Bertrand ME, Moses JW, Ohman EM, Lincoff AM, Ware JH, et al. Routine upstream initiation vs. deferred selective use of glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: the ACUITY Timing trial. JAMA. 2007;297:591–602
  62. Montalescot G, Borentain M, Payot L, Collet JP, Thomas D. Early vs. late administration of glycoprotein IIb/IIIa inhibitors in primary percutaneous coronary intervention of acute ST-segment elevation myocardial infarction: a meta-analysis. JAMA. 2004;292:362–366
  63. Cannon CP, Weintraub WS, Demopoulos LA, Vicari R, Frey MJ, Lakkis N, et al. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. N Engl J Med. 2001;344:1879–1887
  64. Ajani AE, Waksman R, Gruberg L, Sharma AK, Lew R, Pinnow E, et al. Acute procedural complications and in-hospital events after percutaneous coronary interventions: eptifibatide versus abciximab. Cardiovasc Radiat Med. 2003;4:12–17
  65. Roffi M, Moliterno DJ, Meier B, Powers ER, Grines CL, DiBattiste PM, et al. Impact of different platelet glycoprotein IIb/IIIa receptor inhibitors among diabetic patients undergoing percutaneous coronary intervention: do Tirofiban and ReoPro Give Similar Efficacy Outcomes Trial (TARGET) 1-year follow-up. Circulation. 2002;105:2730–2736
  66. Brophy JM, Joseph L. Medical decision making with incomplete evidence—choosing a platelet glycoprotein IIb/IIIa receptor inhibitor for percutaneous coronary interventions. Med Decis Making. 2005;25:222–228
  67. Moliterno DJ, Yakubov SJ, DiBattiste PM, Herrmann HC, Stone GW, Macaya C, et al. Outcomes at 6 months for the direct comparison of tirofiban and abciximab during percutaneous coronary revascularisation with stent placement: the TARGET follow-up study. Lancet. 2002;360:355–360
  68. Suleiman M, Gruberg L, Hammerman H, Aronson D, Halabi M, Goldberg A, et al. Comparison of two platelet glycoprotein IIb/IIIa inhibitors, eptifibatide and abciximab: outcomes, complications and thrombocytopenia during percutaneous coronary intervention. J Invasive Cardiol. 2003;15:319–323
  69. O'Shea JC, Tcheng JE. Eptifibatide: a potent inhibitor of the platelet receptor integrin glycoprotein IIb/IIIa. Expert Opin Pharmacother. 2002;3:1199–1210
  70. Lakkis N, Lakiss N, Bobek J, Farmer J. Platelet inhibition with tirofiban early during percutaneous coronary intervention: dosing revisited. Catheter Cardiovasc Interv. 2002;56:474–477
  71. Lincoff AM, Califf RM, Topol EJ. Platelet glycoprotein IIb/IIIa receptor blockade in coronary artery disease. J Am Coll Cardiol. 2000;35:1103–1115
  72. Kochman W, Dobrzycki S, Nowak KS, Chlopicki S, Kralisz P, Prokopczuk P, et al. Safety and feasibility of a novel dosing regimen of tirofiban administered in patients with acute myocardial infarction with ST elevation before primary coronary angioplasty: a pilot study. J Thromb Thrombolysis. 2004;17:127–131
  73. Ernst NM, Suryapranata H, Miedema K, Slingerland RJ, Ottervanger JP, Hoorntje JC, et al. Achieved platelet aggregation inhibition after different antiplatelet regimens during percutaneous coronary intervention for ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2004;44:1187–1193
  74. Deibele AJ, Kirtane AJ, Pinto DS, Lucca MJ, Neva C, Shui A, et al. Intracoronary bolus administration of eptifibatide during percutaneous coronary stenting for non ST elevation myocardial infarction and unstable angina. J Thromb Thrombolysis. 2006;22:47–50
  75. Ottervanger JP, Armstrong P, Barnathan ES, Boersma E, Cooper JS, Ohman EM, et al. Long-term results after the glycoprotein IIb/IIIa inhibitor abciximab in unstable angina: one-year survival in the GUSTO IV-ACS (Global Use of Strategies To Open Occluded Coronary Arteries IV—Acute Coronary Syndrome) Trial. Circulation. 2003;107:437–442
  76. Denardo SJ, Davis KE, Reid PR, Tcheng JE. Efficacy and safety of minimal dose (< or =1,000 units) unfractionated heparin with abciximab in percutaneous coronary intervention. Am J Cardiol. 2003;91:1–5
  77. Denardo SJ, Davis KE, Tcheng JE. Elective percutaneous coronary intervention using broad-spectrum antiplatelet therapy (eptifibatide, clopidogrel, and aspirin) alone, without scheduled unfractionated heparin or other antithrombin therapy. Am Heart J. 2005;149:138–144
  78. Kaluski E, Hendler A, Uriel N, Milo-Cotter O, Vered Z, Krakover R, et al. Adjunctive pharmacotherapy for coronary interventions—time to read the writing on the wall. Acute Cardiac Care. 2006;8:186–195
  79. Fischell TA, Attia T, Rane S, Salman W. High-dose, single-bolus eptifibatide: a safe and cost-effective alternative to conventional glycoprotein IIb/IIIa inhibitor use for elective coronary interventions. J Invasive Cardiol. 2006;18:487–491
  80. Bilsel T, Akbulut T, Yesilcimen K, Terzi S, Sayar N, Dayi SU, et al. Single high-dose bolus tirofiban with high-loading-dose clopidogrel in primary coronary angioplasty. Heart Vessels. 2006;21:102–107
  81. Danzi GB, Capuano C, Sesana M, Baglini R. Preliminary experience with a high bolus dose of tirofiban during percutaneous coronary intervention. Curr Med Res Opin. 2003;19:28–33

PII: S1553-8389(07)00051-6

doi: 10.1016/j.carrev.2007.03.007

Cardiovascular Revascularization Medicine
Volume 8, Issue 4 , Pages 281-288 , October 2007

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