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

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

› Author Affiliations

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

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