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DOI: 10.1055/s-2004-861506
Controversies Surrounding Platelet Glycoprotein IIb/IIIa Inhibitors in Percutaneous Coronary Intervention and Acute Coronary Syndromes
Publikationsverlauf
Publikationsdatum:
04. Januar 2005 (online)
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ABSTRACT
Platelet-dependent thrombosis is an important part of the pathophysiology of both percutaneous coronary interventions (PCI) and acute coronary syndrome (ACS). Data support the use of acute therapies that interfere with platelets to provide clinical benefit to patients presenting with acute cardiovascular disease. The discovery of platelet glycoprotein (GP) IIb/IIIa receptor antagonists has been a major advance in the pharmacotherapy for patients undergoing PCI and those presenting with ACS without ST-segment elevation. This article will cover the role of platelets in acute cardiovascular disease, as well as the discovery and development of the platelet GPIIb/IIIa inhibitors. The major focus of this article will be on examining key lessons from the trials in each of these areas as well as presenting a series of questions that still require answers from either ongoing or future research.
KEYWORDS
Percutaneous coronary intervention - acute coronary syndrome - platelets - thrombosis - glycoprotein IIb/IIIa antagonists - cardiovascular diseases
REFERENCES
- 1 Tolleson T R, Harrington R A. Thrombosis in acute coronary syndromes and coronary interventions. In: Lincoff AM, Topol EJ Platelet Glycoprotein IIb/IIIa Inhibitors in Cardiovascular Disease. Totowa; Humana Press Inc. 1999
- 2 Antithrombotic Trialists’ Collaboration . Collaborative meta-analysis of randomised trials of antiplatelet therapy for prevention of death, myocardial infarction, and stroke in high risk patients. BMJ. 2002; 324 71-86
- 3 Coller B S. Blockade of platelet GPIIb/IIIa receptors as an antithrombotic strategy. Circulation. 1995; 92 2373-2380
- 4 Kong D F, Hasselblad V, Harrington R A et al.. Meta-analysis of survival with platelet glycoprotein IIb/IIIa antagonists for percutaneous coronary interventions. Am J Cardiol. 2003; 92 651-655
- 5 Boersma E, Harrington R A, Moliterno D J 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
- 6 Grüntzig A R, Senning A, Siegenthaler W E. Nonoperative dilatation of coronary-artery stenosis: percutaneous transluminal coronary angioplasty. N Engl J Med. 1979; 301 61-68
- 7 Karvouni E, Katritsis D G, Ioannidis J P. Intravenous glycoprotein IIb/IIIa receptor antagonists reduce mortality after percutaneous coronary interventions. J Am Coll Cardiol. 2003; 41 26-32
- 8 Topol E J, Lincoff A M, Kereiakes D J et al.. Multi-year follow-up of abciximab therapy in three randomized, placebo-controlled trials of percutaneous coronary revascularization. Am J Med. 2002; 113 1-6
- 9 Lincoff A M, Califf R M, Anderson K M et al.. Evidence for prevention of death and myocardial infarction with platelet membrane glycoprotein IIb/IIIa receptor blockade by abciximab (c7E3 Fab) among patients with unstable angina undergoing percutaneous coronary revascularization. EPIC Investigators. Evaluation of 7E3 in Preventing Ischemic Complications. J Am Coll Cardiol. 1997; 30 49-56
- 10 ESPRIT Investigators . Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy. Novel dosing regimen of eptifibatide in planned coronary stent implantation (ESPRIT): a randomised, placebo-controlled trial. Lancet. 2000; 356 2037-2044
- 11 Randomised placebo-controlled trial of abciximab before and during coronary intervention in refractory unstable angina: the CAPTURE Study. Lancet. 1997; 349 1429-1435
- 12 Lefkovits J, Blankenship J C, Anderson K M 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
- 13 Topol E J, Moliterno D J, Herrmann H C et al.. Do tirofiban and ReoPro give similar efficacy trial. Comparison of two platelet glycoprotein IIb/IIIa inhibitors, tirofiban and abciximab, for the prevention of ischemic events with percutaneous coronary revascularization for TARGET Investigators. N Engl J Med. 2001; 344 1888-1894
- 14 Steinhubl S R, Talley J D, Braden G A et al.. Point-of-care measured platelet inhibition correlates with a reduced risk of an adverse cardiac event after percutaneous coronary intervention: results of the GOLD. Circulation. 2001; 103 2572-2578
- 15 Batchelor W B, Tolleson T R, Huang Y et al.. Randomized comparison of platelet inhibition with abciximab, tirofiban and eptifibatide during percutaneous coronary intervention in acute coronary syndromes: the COMPARE trial. Comparison of measurements of platelet aggregation with aggrastat, reopro, and eptifibatide. Circulation. 2002; 106 1470-1476
- 16 Phillips D R, Teng W, Arfsten A et al.. Effect of Ca2+ on GP IIb-IIIa interactions with integrilin: enhanced GP IIb-IIIa binding and inhibition of platelet aggregation by reductions in the concentration of ionized calcium in plasma anticoagulated with citrate. Circulation. 1997; 96 1488-1494
- 17 Aguirre F V, Topol E J, Ferguson J J et al.. Bleeding complications with the chimeric antibody to platelet glycoprotein IIb/IIIa integrin in patients undergoing percutaneous coronary intervention. EPIC Investigators. Circulation. 1995; 91 2882-2890
- 18 Platelet glycoprotein IIb/IIIa receptor blockade and low-dose heparin during percutaneous coronary revascularization. The EPILOG Investigators. N Engl J Med. 1997; 336 1689-1696
- 19 Tolleson T R, O'shea J C, Bittl J A et al.. Relationship between heparin anticoagulation and clinical outcomes in coronary stent intervention: observations from the ESPRIT trial. J Am Coll Cardiol. 2003; 41 386-393
- 20 Topol E J, Mark D B, Lincoff A M et al.. Outcomes at 1 year and economic implications of platelet glycoprotein IIb/IIIa blockade in patients undergoing coronary stenting: results from a multicentre randomised trial. EPISTENT Investigators. Evaluation of Platelet IIb/IIIa Inhibitor for STENTing. Lancet. 1999; 354 2019-2024
- 21 Cohen D J, O'shea J C, Pacchiana C M et al.. ESPRIT investigators. In-hospital costs of coronary stent implantation with and without eptifibatide (the ESPRIT Trial). Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Trial. Am J Cardiol. 2002; 89 61-64
- 22 Harrington R A, Simoons M L. What have we learned from the recent large trials in acute coronary syndromes without ST-segment elevation?. Eur Heart J. 2000; 21 702-704
- 23 Braunwald E, Antman E M, Beasley J W et al.. ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2001; 38 294-295
- 24 Boersma E, Akkerhuis K M, Theroux P et al.. Platelet glycoprotein IIb/IIIa receptor inhibition in non-ST-elevation acute coronary syndromes: early benefit during medical treatment only, with additional protection during percutaneous coronary intervention. Circulation. 1999; 100 2045-2048
- 25 Ohman E M, Granger C B, Harrington R A, Lee K L. Risk stratification and therapeutic decision making in acute coronary syndromes. JAMA. 2000; 284 876-878
- 26 Ohman E M, Armstrong P W, Christenson R H et al.. Cardiac troponin T levels for risk stratification in acute myocardial ischemia. GUSTO IIA Investigators. N Engl J Med. 1996; 335 1333-1341
- 27 Antman E M, Tanasijevic M J, Thompson B et al.. Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med. 1996; 335 1342-1349
- 28 Newby L K, Ohman E M, Christenson R H et al.. Benefit of glycoprotein IIb/IIIa inhibition in patients with acute coronary syndromes and troponin t-positive status: the paragon-B troponin T substudy. Circulation. 2001; 103 2891-2896
- 29 Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes. The PURSUIT Trial Investigators. Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy. N Engl J Med. 1998; 339 436-443
- 30 Peterson E D, Pollack C V, Roe M T et al.. Early use of glycoprotein IIb/IIIa inhibitors in non-ST-elevation acute myocardial infarction. J Am Coll Cardiol. 2003; 42 45-53
- 31 Mark D B, Harrington R A, Lincoff A M et al.. Cost-effectiveness of platelet glycoprotein IIb/IIIa inhibition with eptifibatide in patients with non-ST-elevation acute coronary syndromes. Circulation. 2000; 101 366-371
Robert A HarringtonM.D.
Duke Clinical Research Institute, Duke University Medical Center
2400 Pratt Street, Durham, NC 27705
eMail: harri019@dcri.duke.edu