The evolving role of glycoprotein IIb/IIIa inhibitors in the setting of percutaneous coronary intervention strategies to minimize bleeding risk and optimize outcomes

Elias B Hanna; Sunil V Rao; Steven V Manoukian; Jorge F Saucedo

doi:10.1016/j.jcin.2010.09.015

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The evolving role of glycoprotein IIb/IIIa inhibitors in the setting of percutaneous coronary intervention strategies to minimize bleeding risk and optimize outcomes

Journal article

Open access

Peer reviewed

The evolving role of glycoprotein IIb/IIIa inhibitors in the setting of percutaneous coronary intervention strategies to minimize bleeding risk and optimize outcomes

Elias B Hanna, Sunil V Rao, Steven V Manoukian and Jorge F Saucedo

JACC. Cardiovascular interventions, Vol.3(12), pp.1209-1219

12/2010

DOI: 10.1016/j.jcin.2010.09.015

PMID: 21232714

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Abstract

The use of glycoprotein IIb/IIIa inhibitors (GPI) reduces ischemic events in patients undergoing percutaneous coronary intervention (PCI). However, the same properties that confer this benefit lead to an increased bleeding risk. Recent studies have shown a less robust net clinical benefit of GPI in the current era of routine thienopyridine and direct thrombin inhibitor use. To optimize the net clinical benefit of GPI, these agents need to be selectively used in patients most likely to benefit from their anti-ischemic effect, namely patients undergoing PCI for non-ST-segment elevation myocardial infarction, select patients undergoing primary PCI, and select patients undergoing PCI without appropriate pre-loading with a thienopyridine. Moreover, strategies to minimize bleeding should be applied in these patients and include shorter GPI infusions (in some patients), dose adjustments of heparin and GPI, careful access site management with more frequent use of the transradial approach, use of smaller sheaths, and identification of patients at high bleeding risk. This review provides an update of the current literature that supports these measures, an insight on the tailored use of GPI, and a potential direction for future research addressing combined antithrombotic therapies.

Acute Coronary Syndrome - drug therapy

Acute Coronary Syndrome - therapy

Angioplasty, Balloon, Coronary - instrumentation

Angioplasty, Balloon, Coronary - methods

Anticoagulants - therapeutic use

Antithrombins - therapeutic use

Coronary Artery Disease - drug therapy

Coronary Artery Disease - therapy

Hemorrhage - drug therapy

Hemorrhage - etiology

Hemorrhage - prevention & control

Hirudins

Humans

Peptide Fragments - therapeutic use

Peptides - therapeutic use

Platelet Aggregation Inhibitors - therapeutic use

Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors

Recombinant Proteins - therapeutic use

Risk Assessment - methods

Risk Factors

Treatment Outcome

Details

Title: Subtitle: The evolving role of glycoprotein IIb/IIIa inhibitors in the setting of percutaneous coronary intervention strategies to minimize bleeding risk and optimize outcomes
Creators: Elias B Hanna - Louisiana State University
Sunil V Rao - Duke University
Steven V Manoukian - HCA Healthcare
Jorge F Saucedo - University of Oklahoma Health Sciences Center
Resource Type: Journal article
Publication Details: JACC. Cardiovascular interventions, Vol.3(12), pp.1209-1219
DOI: 10.1016/j.jcin.2010.09.015
PMID: 21232714
NLM abbreviation: JACC Cardiovasc Interv
ISSN: 1936-8798
eISSN: 1876-7605
Grant note: DOI: 10.13039/100010891, name: Portola Pharmaceuticals; DOI: 10.13039/100006479, name: Cordis Corporation; DOI: 10.13039/100004336, name: Novartis; DOI: 10.13039/100008951, name: Medicure
Language: English
Date published: 12/2010
Academic Unit: Cardiovascular Medicine; Internal Medicine
Record Identifier: 9984359800302771

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