What is the Role for Glycoprotein IIB/IIIA Inhibitor Use in the Catheterization Laboratory in the Current Era?

BACKGROUND: In the era of dual antiplatelet therapy of aspirin and clopidogrel and systematic stent implantation, Glycoprotein IIb/IIIa Inhibitors (GPI), including abciximab, eptifibatide and tirofiban, proved beneficial in improving early outcome of Percutaneous Coronary Intervention (PCI), especially in higher risk clinical and/or anatomical subsets. This was associated however, with an increased incidence of bleeding complications. OBJECTIVE: To review whether the established results of GPI in PCI are maintained in the contemporary era of more effective antiplatelet agents (i.e., prasugrel, ticagrelor and cangrelor) and safer anticoagulants (i.e., bivalirudin) and interventional techniques (i.e., radial approach). METHODS: The most relevant evidence on the use of GPI in stable coronary artery disease, non-STelevation coronary syndromes and ST-elevation myocardial infarction was reviewed. RESULTS: Overall the relative efficacy and safety of GPI in contemporary PCI is maintained, largely irrespective of the use of more effective antiplatelet agents and/or safer anticoagulants and interventional techniques. However, an increase in the absolute occurrence of major and/or minor bleeding and/or need for blood transfusions is generally observed. CONCLUSION: Because of the persistent benefit of GPI in limiting early ischemic complications, especially in higher risk clinical and/or anatomical subsets, and the associated risk of increased bleeding complications, also in contemporary PCI, these agents should currently be used on a selective rather than routine basis, including bail out administration for peri-procedural thrombotic complications.