Glycoprotein IIb/IIIa inhibitors: questioning indications and treatment algorithms

Edo Kaluski, Bunyad Haider, Olga Milo-Cotter, Marc Klapholz

Research output: Contribution to journalReview article

1 Citation (Scopus)

Abstract

Glycoprotein inhibitors (GPI) are viewed as beneficial adjunctive pharmacotherapy agents for percutaneous coronary interventions (PCIs). The major benefit of GPI is derived from the reduction of ischemic events (mostly non-Q-wave myocardial infarctions) during PCI. There is no single randomized clinical trial demonstrating that any of these agents significantly reduces mortality in any clinical subset of patients. Studies of sustained oral GPI resulted in excessive death and myocardial infarctions. Reduction of ischemic end points was counteracted by excessive bleeding, vascular complications, and thrombocytopenia. These complications bear considerable medical and economic impact. The Acute Catheterization and Early Intervention Triage Strategy trial demonstrated that GPI, when added to heparin, enoxaparine, or bivalirudin, do not reduce mortality or ischemic events but significantly increase bleeding complications. Major bleeding resulted in threefold mortality at 1 year. In view of available data, the use of GPI should be limited to moderate-risk to high-risk PCI patients with low bleeding propensity. Protocols of abbreviated GPI administration and careful bleeding surveillance, in conjunction with lower doses of unfractionated heparin or new and possibly safer antithrombins, can potentially improve patient safety.

Original languageEnglish (US)
Pages (from-to)281-288
Number of pages8
JournalCardiovascular Revascularization Medicine
Volume8
Issue number4
DOIs
StatePublished - Oct 1 2007

Fingerprint

Platelet Glycoprotein GPIIb-IIIa Complex
Glycoproteins
Hemorrhage
Percutaneous Coronary Intervention
Heparin
Mortality
Therapeutics
Myocardial Infarction
Medical Economics
Enoxaparin
Antithrombins
Triage
Patient Safety
Catheterization
Thrombocytopenia
Blood Vessels
Randomized Controlled Trials
Drug Therapy

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Keywords

  • Bleeding
  • Glycoprotein IIb/IIIa
  • Inhibitors
  • Thrombocytopenia
  • Treatment algorithms

Cite this

Kaluski, Edo ; Haider, Bunyad ; Milo-Cotter, Olga ; Klapholz, Marc. / Glycoprotein IIb/IIIa inhibitors : questioning indications and treatment algorithms. In: Cardiovascular Revascularization Medicine. 2007 ; Vol. 8, No. 4. pp. 281-288.
@article{7ce44e49a74d44429114f462c5668dae,
title = "Glycoprotein IIb/IIIa inhibitors: questioning indications and treatment algorithms",
abstract = "Glycoprotein inhibitors (GPI) are viewed as beneficial adjunctive pharmacotherapy agents for percutaneous coronary interventions (PCIs). The major benefit of GPI is derived from the reduction of ischemic events (mostly non-Q-wave myocardial infarctions) during PCI. There is no single randomized clinical trial demonstrating that any of these agents significantly reduces mortality in any clinical subset of patients. Studies of sustained oral GPI resulted in excessive death and myocardial infarctions. Reduction of ischemic end points was counteracted by excessive bleeding, vascular complications, and thrombocytopenia. These complications bear considerable medical and economic impact. The Acute Catheterization and Early Intervention Triage Strategy trial demonstrated that GPI, when added to heparin, enoxaparine, or bivalirudin, do not reduce mortality or ischemic events but significantly increase bleeding complications. Major bleeding resulted in threefold mortality at 1 year. In view of available data, the use of GPI should be limited to moderate-risk to high-risk PCI patients with low bleeding propensity. Protocols of abbreviated GPI administration and careful bleeding surveillance, in conjunction with lower doses of unfractionated heparin or new and possibly safer antithrombins, can potentially improve patient safety.",
keywords = "Bleeding, Glycoprotein IIb/IIIa, Inhibitors, Thrombocytopenia, Treatment algorithms",
author = "Edo Kaluski and Bunyad Haider and Olga Milo-Cotter and Marc Klapholz",
year = "2007",
month = "10",
day = "1",
doi = "10.1016/j.carrev.2007.03.007",
language = "English (US)",
volume = "8",
pages = "281--288",
journal = "Cardiovascular Revascularization Medicine",
issn = "1553-8389",
publisher = "Elsevier Inc.",
number = "4",

}

Glycoprotein IIb/IIIa inhibitors : questioning indications and treatment algorithms. / Kaluski, Edo; Haider, Bunyad; Milo-Cotter, Olga; Klapholz, Marc.

In: Cardiovascular Revascularization Medicine, Vol. 8, No. 4, 01.10.2007, p. 281-288.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Glycoprotein IIb/IIIa inhibitors

T2 - questioning indications and treatment algorithms

AU - Kaluski, Edo

AU - Haider, Bunyad

AU - Milo-Cotter, Olga

AU - Klapholz, Marc

PY - 2007/10/1

Y1 - 2007/10/1

N2 - Glycoprotein inhibitors (GPI) are viewed as beneficial adjunctive pharmacotherapy agents for percutaneous coronary interventions (PCIs). The major benefit of GPI is derived from the reduction of ischemic events (mostly non-Q-wave myocardial infarctions) during PCI. There is no single randomized clinical trial demonstrating that any of these agents significantly reduces mortality in any clinical subset of patients. Studies of sustained oral GPI resulted in excessive death and myocardial infarctions. Reduction of ischemic end points was counteracted by excessive bleeding, vascular complications, and thrombocytopenia. These complications bear considerable medical and economic impact. The Acute Catheterization and Early Intervention Triage Strategy trial demonstrated that GPI, when added to heparin, enoxaparine, or bivalirudin, do not reduce mortality or ischemic events but significantly increase bleeding complications. Major bleeding resulted in threefold mortality at 1 year. In view of available data, the use of GPI should be limited to moderate-risk to high-risk PCI patients with low bleeding propensity. Protocols of abbreviated GPI administration and careful bleeding surveillance, in conjunction with lower doses of unfractionated heparin or new and possibly safer antithrombins, can potentially improve patient safety.

AB - Glycoprotein inhibitors (GPI) are viewed as beneficial adjunctive pharmacotherapy agents for percutaneous coronary interventions (PCIs). The major benefit of GPI is derived from the reduction of ischemic events (mostly non-Q-wave myocardial infarctions) during PCI. There is no single randomized clinical trial demonstrating that any of these agents significantly reduces mortality in any clinical subset of patients. Studies of sustained oral GPI resulted in excessive death and myocardial infarctions. Reduction of ischemic end points was counteracted by excessive bleeding, vascular complications, and thrombocytopenia. These complications bear considerable medical and economic impact. The Acute Catheterization and Early Intervention Triage Strategy trial demonstrated that GPI, when added to heparin, enoxaparine, or bivalirudin, do not reduce mortality or ischemic events but significantly increase bleeding complications. Major bleeding resulted in threefold mortality at 1 year. In view of available data, the use of GPI should be limited to moderate-risk to high-risk PCI patients with low bleeding propensity. Protocols of abbreviated GPI administration and careful bleeding surveillance, in conjunction with lower doses of unfractionated heparin or new and possibly safer antithrombins, can potentially improve patient safety.

KW - Bleeding

KW - Glycoprotein IIb/IIIa

KW - Inhibitors

KW - Thrombocytopenia

KW - Treatment algorithms

UR - http://www.scopus.com/inward/record.url?scp=36448991610&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=36448991610&partnerID=8YFLogxK

U2 - 10.1016/j.carrev.2007.03.007

DO - 10.1016/j.carrev.2007.03.007

M3 - Review article

C2 - 18053951

AN - SCOPUS:36448991610

VL - 8

SP - 281

EP - 288

JO - Cardiovascular Revascularization Medicine

JF - Cardiovascular Revascularization Medicine

SN - 1553-8389

IS - 4

ER -