Key result
Combination therapy with fibrinolytics and GP IIb/IIIa inhibitors reduced composite ischemic endpoints in acute MI (p=0.001 and p=0.0001), though nonintracranial major bleeding increased.
Why the study?
Does combination therapy of a fibrinolytic and a GP IIb/IIIa receptor inhibitor reduce death or reinfarction in patients with acute myocardial infarction?
Does combination therapy of a fibrinolytic and a GP IIb/IIIa receptor inhibitor reduce death or reinfarction in patients with acute myocardial infarction?
Combination therapy with fibrinolytics and GP IIb/IIIa inhibitors improves ischemic outcomes in acute MI but increases nonintracranial bleeding risk, and is contraindicated in patients >75 years.
Increases bleeding caution with fibrinolytic-GP IIb/IIIa combinations in acute MI; leaves open net benefit versus contemporary reperfusion.
The combined use of a fibrinolytic and a platelet glycoprotein (GP) IIb/IIIa receptor inhibitor to target the fibrin and platelet components of occlusive thrombi offers the potential for more rapid and complete reperfusion in patients with acute myocardial infarction (MI), although there have been concerns about the safety of this combination therapy. Data from the recent GUSTO-V and the ASSENT-3 trials support the use of this regimen in that the 30-day death or nonfatal reinfarction rate (7 days) in GUSTO-V and death or in-hospital reinfarction or in-hospital refractory ischemia rate in ASSENT-3 were reduced (p = 0.001 and p = 0.0001, respectively). The need for revascularization in both these trials was also reduced significantly. There was no increased risk of intracranial hemorrhage or stroke with the combination therapy, but an increased rate of nonintracranial severe or major bleeding was observed. At present, patients aged > 75 years should not receive combination therapy. Further studies in subgroup patient populations are warranted.
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Manoharan et al. (2004) conducted a review in Acute myocardial infarction. Fibrinolytics plus glycoprotein IIb/IIIa receptor inhibitors was evaluated on 30-day death or nonfatal reinfarction (GUSTO-V) and death or in-hospital reinfarction or refractory ischemia (ASSENT-3) (p=0.001 and 0.0001). Combination therapy with fibrinolytics and GP IIb/IIIa inhibitors reduced composite ischemic endpoints in acute MI (p=0.001 and p=0.0001), though nonintracranial major bleeding increased.
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