Diabetes Mellitus, Glycoprotein IIb/IIIa Blockade, and Heparin

Abstract

Background-After angioplasty, major complications and ischemic events occur more frequently in diabetic than nondiabetic patients. To determine whether treatment with abciximab is effective in reducing these events in diabetics, we analyzed characteristics and outcomes of diabetic patients enrolled in a large multicenter study (EPILOG). Methods and Results-Of 2792 patients enrolled, 638 (23%) were diabetic. Diabetic patients were older, shorter, and heavier; more likely to be female and have three-vessel disease, prior coronary artery bypass graft surgery, a history of hypertension, or a recent myocardial infarction; and less likely to be current smokers than their nondiabetic counterparts. During hospitalization, death, myocardial infarction, or urgent revascularization occurred in 7.1% of diabetics and 7.5% of nondiabetics. By 6 months, the composite of death and myocardial infarction had occurred in 8.8% of diabetic patients and 7.4% of nondiabetics, whereas death, myocardial infarction, or revascularization had occurred in 27.2% and 22.6%, respectively. Abciximab treatment reduced death or myocardial infarction among diabetic and nondiabetic patients (hazard ratios, 0. When standard-and low-dose heparin adjuncts were compared, diabetics receiving abciximab with standard-dose heparin had marginally greater reductions in the composite of death and myocardial infarction and in target vessel revascularization than diabetics assigned to abciximab with low-dose heparin. Conclusions-Abciximab treatment in diabetic patients led to a reduction in the composite of death and myocardial infarction, which was at least as great as that seen in nondiabetic patients. However, target vessel revascularization was reduced in nondiabetic but not diabetic patients. This effect may be associated in part with lower doses of heparin. These differences may be related to differences in the platelet and coagulation systems between diabetics and nondiabetics, the greater extent of coronary artery disease in diabetics, or patient selection and management factors. (Circulation. 1998;97:1912-1920.)

Platelet activation in type 2 diabetes mellitus

“…Treatment with abciximab (a chimeric monoclonal antibody against the glycoprotein complex GpIIb/ IIIa) reduced the number of deaths and myocardial infarction as well as the number of emergency revascularization procedures both in diabetic and non-diabetic patients, as assessed in the EPILOG study [96]. More recently, the addition to standard antithrombotic therapy of the non-peptide platelet Type 2 diabetes mellitus (n ¼ 50 vs. 32) 5.94 ± 3.68à 1.50 ± 0.79à [22] Values are expressed as mean ± SD; *pg mg )1 creatinine; value expressed as range; §ng h )1 ; ànmol die )1 .…”

Antithrombotic therapy in hypertension: a Cochrane Systematic review

“…24 Five studies investigating ticlopidine and glycoprotein IIb/IIIa inhibitors and their impact on cardiovascular and haemorrhagic events lacked sufficient follow-up data. [25][26][27][28][29] A further publication was excluded due to the inability to acquire the relevant data. 30 Most of the excluded trials were less than 1-month duration; in particular, the five GPIIb/IIIa inhibitor trials were only observing the effects over a few days.…”

Important Triad in Cardiovascular Medicine

“…The baseline (placebo group) risk for TVR was higher among diabetics than non-diabetics in all trials except EPILOG, in keeping with previous studies demonstrating an increased likelihood of restenosis among diabetic patients. The lower TVR rate among diabetics in the placebo group of EPILOG 21 was likely a chance spurious finding. In contrast to the consistent influence of GP IIb/IIIa inhibition on acute ischemic events (Figure 1), the effect of these agents on 6-month rates of TVR varied considerably among trials and between diabetic or non-diabetic subgroups (Figure 2).…”

“…The Evaluation of c7E3 for Prevention of Ischemic Complications (EPIC), 18,19 Evaluation in PTCA to Improve Long-term Outcome with abciximab GP IIb/IIIa blockade (EPILOG), 20,21 and Evaluation of Platelet Inhibition in STENTing (EPISTENT) 3,22-24 trials compared abciximab to placebo among patients undergoing non-stent interventions (EPIC, EPILOG, and 1 arm of EPISTENT) or stenting (2 arms of EPISTENT). The Enhanced Suppression of the Platelet IIb/IIIa Receptor with Integrilin Therapy (ES-PRIT) 2,17,25,26 trial compared eptifibatide to placebo and the do Tirofiban And ReoPro Give similar Efficacy Trial (TAR-GET) 27 compared tirofiban to abciximab during stenting.…”