Glycoprotein IIb/IIIa antagonists

U. Zeymer; R. Zahn

doi:10.1055/s-0037-1617132

Hämostaseologie, Table of Contents

Hamostaseologie 2009; 29(04): 334-337
DOI: 10.1055/s-0037-1617132

Review

Schattauer GmbH

Glycoprotein IIb/IIIa antagonists

New developmentsGlykoprotein-IIb/IIIa-AntagonistenNeuentwicklungen

Authors

U. Zeymer

¹Herzzentrum Ludwigshafen und Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg
R. Zahn

¹Herzzentrum Ludwigshafen und Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg

Abstract

Summary

The role of GP IIb/IIIa antagonists has been focused on patients with acute coronary syndromes undergoing PCI. In the ISAR-REACT 2 study abciximab given in patients with NSTEACS undergoing PCI already treated with 600 mg clopidogrel improved 30-day death and reinfarction rate in troponin positive patients. In the large EARLY-ACS trial upstream therapy with eptifibatide in high risk with NSTE-ACS did not improve ischaemic complications but was associated with an increase in bleeding complications. Therefore GP IIb/IIIa antagonists should be given after the initial angiography and the decision the perform PCI in troponin positive patients with NSTE-ACS.

In patients with STEMI undergoing primary PCI the prehospital administration of tirofiban was associated with an improved myocardial reperfusion. In contrast in the BRAVE 3 trial abciximab in patients with pretreatment with 600 mg clopidogrel did not reduce infarct size or improve clinial outcome. Comparative trials evaluating the effectiveness of abciximab and the small molecules tirofiban and eptifibatide did not show any differences between the three GP IIb/IIIa antagoniosts.

Zusammenfassung

Die Rolle von GP-IIb/IIIa-Inhibitoren hat sich auf den Einsatz bei Patienten mit akuten koronaren Syndromen fokussiert. In der ISAR-REACT 2 Studie reduzierte Abciximab den kombinierten Endpunkt von Tod und Reinfarkt bei Patienten mit Tropinin-positiven NSTEACS und PCI sowie Vortherapie mit 600 mg Clopidogrel. In der großen EARLY-ACS-Studie führte die Upstream-Therapie mit Eptifibatide bei Patienten mit NSTE-ACS nicht zu einer Reduktion de ischämischen Ereignisse, aber zu einem Anstieg von Blutungskomplikationen. Daher sollten GP-IIb/IIIa-Inhibitoren bei Patienten mit NSTE-ACS und positivem Troponin nach der initialen Angiographie und der Entscheidung zur PCI gegeben werden.

Die prähospitale Gabe von Tirofiban bei Patienten mit STEMI und primärer PCI führte zu einer Verbesserung der myokardialen Re -perfusion in der OnTIME-2-Studie. Dagegen reduzierte die peri-interventionelle Gabe von Abciximab bei Patienten mit STEMI nicht zu einer Reduktion der Infarktgröße bei primärer PCI. Vergleichende randomisierte Studien mit Abciximab und den kleinen Molekülen Eptifibatide und Tirofiban ergaben keine Unterschiede zwischen den drei GP-IIb/IIIa-Inhibitoren bei primärer PCI beim STEMI.

Keywords

Acute coronary syndromes - percutaneous coronary intervention - GP IIb/IIIa antagonists - clinical trials

Schlüsselwörter

Akute koronare Syndrome - perkutane koronare Intervention - GP-IIb/IIIa-Inhibitoren - klinische Studien

Full Text

References

References
1 Boersma E, Akkerhuis KM, 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.
2 Boersma E, Harrington RA, Moliterno DJ. 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.
3 Kastrati A, Mehilli J, Schühlen H. et al. A clinical trial of abciximab in elective percutaneous intervention after pretreatment with clopidogrel. N Engl J Med 2004; 350: 232-238.
4 Montalescot G, Barragan P, Wittenberg O. et al. Platelet glycoprotein IIb/IIIa inhibition with coronary stenting for acute myocardial infarction. N Engl J Med 2001; 344: 1895-1903.
5 Antoniucci D, Rodriguez A, Hempel A. et al. A randomized trial comparing primary infarct artery stenting with or without abciximab in acuze myocardial infarction. J Am Coll Cardiol 2003; 42: 1879-1885.
6 De Luca G, Suryapranata H, Stone GW. et al. Abciximab as adjunctive therapy to reperfusion in acute ST-segment elevation myocardial infarction: A meta-analysis of randomized trials. JAMA 2005; 293: 1759-1765.
7 Kastrati A, Mehilli J, Neumann FJ. et al. Abciximab in patients with acute coronary syndromes undergoing percutaneous coronary intervention after clopidogrel pretreatment: the ISAR-REACT 2 randomized trial. JAMA 2006; 295: 1531-1538.
8 Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable angina and non-Q-wave myocardial infarction.. Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) Study Investigators. N Engl J Med 1998; 338: 1488–1497; 339 415.
9 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.
10 Roffi M, Chew DP, Mukherjee D. et al. Platelet glyco-protein IIb/IIIa inhibition in acute coronary syndromes. Gradient of benefit related to the revascularization strategy. Eur Heart J 2002; 23: 1441-1448.
11 Effect of glycoprotein IIb/IIIa receptor blocker abciximab on outcome in patients with acute coronary syndromes without early coronary revascularisation: the GUSTO IV-ACS randomised trial. Lancet 2001; 2001: 1915-1924.
12 Anderson JL, Adams CD, Antman EM. et al. ACC/ AHA 2007 guidelines for the management of patients with unstable angina/non-ST-Elevation myocardial infarction. J Am Coll Cardiol 2007; 50: e1-e157.
13 Bassand JP, Hamm CW, Ardissino D. et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Eur Heart J 2007; 28: 1598-660.
14 Novel dosing regimen of eptifibatide in planned coronary stent implantation (ESPRIT): a randomised, placebo-controlled trial. Lancet 2000; 356: 2037-2044.
15 Guigliano RP, White Ja, Bode C. et al. Early versus delayed, provisional eptifibatide in acute coronary-syndromes. N Engl J Med 2009; 360: 2176-2190.
16 Stone GW, Bertrand ME, Moses JW. et al. Routine upstream initiation vs deferred selective use of glycoprotein IIb/IIIa inhibitors in acute coronary syndromes: the ACUITY Timing trial. JAMA 2007; 297: 591-602.
17 Montalescot G, Antonucci D, Kastrati A. et al. Abciximab in primary coronary stenting in STEMI:a European meta analysis of individual patients’ data with long-term follow-up. Eur Heart J 2007; 28: 443-449.
18 Mehilli J, Kastrati A, Schulz S. et al. Abciximab in patients with acute ST-segment-elevation mycardial infarction undergoing primary percutaneous coronary intervention after clopidogrel preloading. Circulation 2009; 119: 1933-1940.
19 De Luca Suryapranata H, Stone GW. et al. Relation-ship between patients risk profile and benefit in mortality from adjunctive abciximab in mechanical revascularization for STEMI. J Am Coll Cardiol 2006; 47: 685-686.
20 De Luca G, Gibson M, Bellandi F. et al. Early GP IIb/ IIA inhibitor in primary angioplasty cooperation (EGYPT). Heart 2008; 94: 1548-1558.
21 Ellis SG, Tendear M, de Belder MA. Faciltated PCI in patients with myocardial infarction. N Engl J Med 2008; 358: 2205-2217.
22 Van’t Hof AWJ, ten Berg J. Prehospital initiation of tirofiban in patients with ST-elevation myocardial infarction undergoing primary angioplasty (On-TIME 2: a multicentre,double-blind, randomised controlled trial. Lancet 2008; 372: 537-546.
23 Zeymer U, Margenet A, Haude M. et al. Randomized comparison of eptifibatide versus abciximab in primary percutaneous coronary intervention in patients with acute ST elevation myocardial infarction. Results of the EVA-AMI trial. J Am Coll Cardiol. (in press).
24 Valgimigli M, Campo G, Percolo G. Comparison of angioplasty with infusion of tirofiban or abciximab and with implantation of sirolimus-eluting or un-coated stents for acute myocardial infarction. The MULTISTRATEGY randomized trial. JAMA 2008; 299: 1788-1799.
25 Marzocchi A, Manari A, Piovaccari G. Randomized comparison between tirofiban and abciximab to promote complete ST resolution in primary angioplasty: results of the facilitated angioplasty with tirofiban or abciximab (FATA) in ST-elevation myocardial infarction trial. Eur Heart J 2008; 29: 2972-2980.
26 DeLuca G, Ucci G, Cassetti E, Marino C. Benefits from small molecule administration as compared to abciximab among patients with ST elevation myocardial infarction treated with primary angioplasty. J Am Coll Cardiol 2009; 53: 1668-1673.