A randomized trial assessing the impact of three different glycoprotein IIb/IIIa antagonists on glycoprotein IIb/IIIa platelet receptor inhibition and clinical endpoints in patients with acute coronary syndromes

作者：Holmes Lewis E; Gupta Rohan; Rajendran Saissan; Luu John; French John K; Juergens Craig P^*

来源：Cardiovascular Therapeutics, 2016, 34(5): 330-336.

DOI：10.1111/1755-5922.12203

• Abciximab
• Acute coronary syndrome
• Eptifibatide
• Glycoprotein IIbIIIa antagonist
• Percutaneous coronary intervention
• Tirofiban

AimsTo compare three glycoprotein IIb/IIIa receptor antagonists (GPIs) in terms of platelet inhibition and major adverse cardiac events (MACEs), and assess the rate of bleeding and MACEs between GPIs and coadministered P2Y12 agents.
MethodsEighty-three acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) with planned GPI use were randomized to receive high-dose bolus tirofiban, double-bolus eptifibatide, or abciximab followed by a 12-hour infusion. Glycoprotein IIb/IIIa platelet receptor inhibition was measured at baseline and at 10minutes, 1hour, and 24hours postbolus dose. Major adverse cardiac events and bleeding complications at 30days were documented. The incidence of MACEs and bleeding in patients receiving ticagrelor or prasugrel were compared to those given clopidogrel.
ResultsThere were no statistically significant differences in platelet inhibition between GPIs at 10minutes (P=.085) and 1hour (P=.337). At 24hours, abciximab achieved statistically significantly higher median [interquartile range] platelet inhibition (75 [65-88]%) compared to tirofiban (28 [3-56]%; P<.0001) and eptifibatide (44 [31-63]%; P=.007). There were no differences in bleeding or MACEs depending on GPI or P2Y12 inhibitor administered.
ConclusionsGlycoprotein receptor inhibitors achieve similar levels of platelet inhibition at 10minutes and 1hour; however, abciximab maintains this benefit 24hours after bolus dose. We did not witness an increased rate of bleeding in patients given new potent P2Y12 inhibitors and a GPI in the modern era.

• 出版日期2016-10