Key result
Glycoprotein IIb/IIIa inhibitors reduced the incidence of death or myocardial infarction in ACS patients not scheduled for early revascularization, despite an increase in major bleeding complications.
Why the study?
Do intravenous glycoprotein IIb/IIIa receptor inhibitors reduce death or myocardial infarction in patients with acute coronary syndromes not scheduled for early revascularisation?
Do intravenous glycoprotein IIb/IIIa receptor inhibitors reduce death or myocardial infarction in patients with acute coronary syndromes not scheduled for early revascularisation?
Intravenous glycoprotein IIb/IIIa inhibitors reduce the risk of death or myocardial infarction in ACS patients managed medically, particularly those at high risk, despite an increase in major bleeding.
May inform selective use in high-risk medically managed ACS despite bleeding; leaves open net benefit with modern antithrombotic regimens.
Four intravenous glycoprotein IIb/IIIa receptor inhibitors (GPIs) (abciximab, eptifibatide, tirofiban and lamifiban) have been tested extensively over the last decade for their efficacy and safety in patients with acute coronary syndromes (ACS). GPIs are well-established adjunct agents for patients undergoing percutaneous coronary intervention, and considerable effort has gone into evaluating these agents in patients who are not scheduled to undergo coronary revascularisation. In the current article, six major randomised clinical trials conducted in the latter patient population are reviewed. Based on a recent meta-analysis of these trials, GPIs reduced the incidence of death or myocardial infarction in patients not scheduled for early revascularisation, with the greatest reduction observed in patients at high risk of thrombotic complications. Major bleeding complications were more frequent in those receiving GPIs, however, the incidences of intracranial haemorrhage and stroke were similar in both treatment groups. Despite these risks, the benefits of GPI therapy in addition to conventional treatment, such as aspirin and heparin, should be considered for these high-risk patients.
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Westerhout et al. (2003) conducted a review in Acute coronary syndromes (ACS). Intravenous glycoprotein IIb/IIIa receptor inhibitors (GPIs) vs. Conventional treatment (aspirin and heparin) was evaluated on Death or myocardial infarction. Glycoprotein IIb/IIIa inhibitors reduced the incidence of death or myocardial infarction in ACS patients not scheduled for early revascularization, despite an increase in major bleeding complications.
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