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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
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Published on: March 15, 2022

[Effectiveness and safety of triple antiaggregation in patients undergoing coronary intervention]

J Latour-Pérez1, E de Miguel-Balsa, A Alcalá-López

  • 1Servicio de Medicina Intensiva, Hospital General de Elche, Alicante. jlatour@coma.es

Medicina Intensiva
|June 21, 2007
PubMed

Insights

Glycoprotein IIb/IIIa inhibitors reduce adverse cardiac events in non-ST segment elevation acute coronary syndrome (NSTEACS) patients pretreated with aspirin and thienopyridines. However, these inhibitors increase bleeding and thrombocytopenia risks, and their use in stable coronary patients is not justified.

Area of Science:

  • Cardiology
  • Pharmacology
  • Clinical Trials

Background:

  • Acute coronary syndromes (ACS) are a spectrum of clinical presentations of coronary artery disease.
  • Non-ST segment elevation ACS (NSTEACS) requires prompt management to reduce myocardial infarction and death.
  • Percutaneous coronary revascularization (PCR) is a common intervention for coronary artery disease.

Purpose of the Study:

  • To systematically review the effectiveness and safety of glycoprotein IIb/IIIa inhibitors (GPIIb/IIIa inhibitors).
  • To evaluate GPIIb/IIIa inhibitors in patients with NSTEACS or stable coronary disease undergoing PCR.
  • To assess outcomes in patients pre-treated with aspirin and thienopyridines.

Main Methods:

  • Systematic review of randomized controlled trials (RCTs).
  • Electronic searches of major databases (Medline, Embase, Pascal, Cochrane Library, ISI Proceedings).
  • Inclusion of RCTs assessing clinical efficacy (death/infarction) and safety (bleeding/thrombocytopenia).

Main Results:

  • Nine RCTs involving 8,604 patients were analyzed.
  • GPIIb/IIIa inhibitors reduced death or myocardial infarction risk by 33% in NSTEACS patients (RR 0.67; 95%CI 0.56-0.80).
  • No significant benefit was observed in stable coronary disease patients (RR 1.07; 95%CI 0.75-1.53), with increased bleeding and thrombocytopenia risks.

Conclusions:

  • GPIIb/IIIa inhibitors are beneficial in reducing adverse cardiac events for NSTEACS patients pre-treated with dual antiplatelet therapy.
  • The increased risk of severe bleeding and thrombocytopenia necessitates careful consideration.
  • Current evidence does not support the routine use of GPIIb/IIIa inhibitors in stable coronary patients undergoing PCR.
Abstract

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