Efficacy and Safety of Glycoprotein IIb/IIIa Inhibitors During Elective Coronary Revascularization

Winchester, David E.; Wen, Xuerong; Brearley, William D.; Park, Ki; Anderson, R. David; Bavry, Anthony A.

doi:10.1016/j.jacc.2010.10.030

Cited by 58 publications

(8 citation statements)

References 62 publications

(59 reference statements)

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“…The rate of death or myo-cardial infarction at 30 days and 6 months was 5.10% versus 7.52% and 7.51% versus 10.45% in the treatment versus the control groups, respectively. In one of the most recent assessments of the effects of αIIbβ3 blockers, Winchester et al 75 analyzed the results of 22 randomized studies with 10 123 patients undergoing PCI with stenting, who were treated routinely with ADP receptor antagonists (thienopyridines). This analysis showed that at 30 days, patients receiving αIIbβ3 antagonists had a significant reduction in myocardial infarction, 5.1% versus 8.3% in the control group without a significant increase in major bleeds, 1.2% versus 0.9%.…”

Section: Current Usage Of αIibβ3 Antagonistsmentioning

confidence: 99%

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Integrin αIIbβ3

Błędzka

Smyth

Plow

2013

Circulation Research

141

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From the initial description of platelets in 1882, their propensity to aggregate and to contribute to thrombosis was apparent. Indeed, excessive platelet aggregation is associated with myocardial infarction and other thrombotic diseases whereas Glanzmann thrombasthenia, in which platelet aggregation is reduced, is a bleeding syndrome. Over the last half of the 20th century, many investigators have provided insights into the cellular and molecular basis for platelet aggregation. The major membrane protein on platelets, integrin αIIbβ3, mediates this response by rapidly transiting from its resting to an activated state in which it serves as a receptor for ligands that can bridge platelets together. Monoclonal antibodies, natural products, and small peptides were all shown to inhibit αIIbβ3 dependent platelet aggregation, and these inhibitors became the forerunners of antagonists that proceeded through preclinical testing and into large patient trials to treat acute coronary syndromes, particularly in the context of percutaneous coronary interventions. Three such αIIbβ3 antagonists, abciximab, eptifibatide, and tirofiban, received Food and Drug Administration approval. Over the past 15 years, millions of patients have been treated with these αIIbβ3 antagonists and many lives have been saved by their administration. With the side effect of increased bleeding and the development of new antithrombotic drugs, the use of αIIbβ3 antagonists is waning. Nevertheless, they are still widely used for the prevention of periprocedural thrombosis during percutaneous coronary interventions. This review focuses on the biology of αIIbβ3, the development of its antagonists, and some of the triumphs and shortcomings of αIIbβ3 antagonism.

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Section: Current Usage Of αIibβ3 Antagonistsmentioning

confidence: 99%

“…However, overall mortality was not reduced. 75 Ongoing trials using αIIbβ3 inhibitors are focused primarily on reduction of side effects (eg, reduction of bleeding, dosage optimization for patients with renal dysfunction, alternative ways of infusion, treatment of severe sepsis in pneumonia patients).…”

Section: Current Usage Of αIibβ3 Antagonistsmentioning

confidence: 99%

Integrin αIIbβ3

Błędzka

Smyth

Plow

2013

Circulation Research

141

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“…Unfractionated heparin has been widely used for anticoagulation during percutaneous coronary intervention (PCI). The addition of glycoprotein IIb/IIIa inhibitors to unfractionated heparin has been shown to reduce peri-procedural ischemic events compared with heparin alone; however, this approach can increase bleeding risk [ 1 ].…”

Section: Introductionmentioning

confidence: 99%

Critical Appraisal of Bivalirudin versus Heparin for Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Trials

et al. 2015

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Percutaneous coronary intervention with bivalirudin plus bail-out glycoprotein IIb/IIIa inhibitors has been shown to be as effective as unfractionated heparin plus routine glycoprotein IIb/IIIa inhibitors in preventing cardiac ischemic events, but with a lower bleeding risk. It is unknown whether bivalirudin would have the same beneficial effects if compared with heparin when the use of glycoprotein IIb/IIIa inhibitors was similar between treatment arms. We searched the MEDLINE, Web of Science, and Cochrane databases from inception until March 2015 for randomized trials that compared bivalirudin to heparin in patients undergoing percutaneous coronary intervention. We required that the intended use of glycoprotein IIb/IIIa inhibitors was similar between the study groups. Summary estimates were principally constructed by the Peto method. Fifteen trials met our inclusion criteria, which yielded 25,824 patients. Bivalirudin versus heparin was associated with an increased hazard of stent thrombosis (odds ratio [OR] 1.49, 95% confidence interval [CI] 1.15-1.92, P = .002, I2 = 16.9%), with a similar hazard of myocardial infarction (OR 1.09, 95% CI 0.98-1.22, P = .11, I2 = 35.8%), all-cause mortality (OR 0.88, 95% CI 0.72-1.08, P = .21, I2 = 31.5%) and major adverse cardiac events (OR 1.04, 95% CI 0.94-1.14, P = .46, I2 = 53.9%). Bivalirudin was associated with a reduced hazard of major bleeding (OR 0.80, 95% CI 0.70-0.92, P = .001, I2 = 63.5%). The dose of heparin in the control arm modified this association; when the dose of unfractionated heparin in the control arm was ≥ 100 units/kg, bivalirudin was associated with a reduction in major bleeding (OR 0.55, 95% CI 0.45-0.68, P < .0001), but when the dose of unfractionated heparin was ≤ 75 units/kg, bivalirudin was not associated with reduction in bleeding (OR 1.09, 95% CI 0.91-1.31, P = .36). Among patients undergoing PCI, bivalirudin was associated with an increased hazard of stent thrombosis. Bivalirudin may be associated with a reduced hazard of major bleeding; however, this benefit was no longer apparent when compared with a dose of unfractionated heparin ≤ 75 units/kg.

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“…There are several reports on the effect of perioperative myocardial damage reduction and prognosis improvement about these drugs. [ 25 – 27 ] Also as Picchi et al [ 28 ] are trying to show, bivalirudin may have the effect of reducing the thrombus of the culprit lesion to such an amount that OCT imaging can detect in the acute phase of STEMI. These drugs may decrease thrombus volume, improve the quality of OCT image, and further reduce the incidence of FNR.…”

Section: Discussionmentioning

confidence: 99%

The combination assessment of lipid pool and thrombus by optical coherence tomography can predict the filter no-reflow in primary PCI for ST elevated myocardial infarction

et al. 2017

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The usefulness of distal protection devices is still controversial. Moreover, there is no report on thrombus evaluation by using optical coherence tomography (OCT) for determining whether to use a distal protection device. The aim of the present study was to investigate the predictor of filter no-reflow (FNR) by using OCT in primary percutaneous coronary intervention (PCI) for ST-elevated acute myocardial infarction (STEMI).We performed preinterventional OCT in 25 patients with STEMI who were undergoing primary PCI with Filtrap. FNR was defined as coronary flow decreasing to TIMI flow grade 0 after mechanical dilatation.FNR was observed in 13 cases (52%). In the comparisons between cases with or without the FNR, the stent length, lipid pool length, lipid pool + thrombus length, and lipid pool + thrombus index showed significant differences. In multivariate analysis, lipid pool + thrombus length was the only independent predictor of FNR (OR 1.438, 95% CI 1.001 - 2.064, P < .05). The optimal cut-off value of lipid pool + thrombus length for predicting FNR was 13.1 mm (AUC = 0.840, sensitivity 76.9%, specificity 75.0%). Moreover, when adding the evaluation of thrombus length to that of lipid pool length, the prediction accuracy of FNR further increased (IDI 0.14: 0.019–0.25, P = .023).The longitudinal length of the lipid pool plus thrombus was an independent predictor of FNR and the prediction accuracy improved by adding the thrombus to the lipid pool. These results might be useful for making intraoperative judgment about whether filter devices should be applied in primary PCI for STEMI.

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Efficacy and Safety of Glycoprotein IIb/IIIa Inhibitors During Elective Coronary Revascularization

Cited by 58 publications

References 62 publications

Integrin αIIbβ3

Integrin αIIbβ3

Critical Appraisal of Bivalirudin versus Heparin for Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Trials

The combination assessment of lipid pool and thrombus by optical coherence tomography can predict the filter no-reflow in primary PCI for ST elevated myocardial infarction

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