Affordable Access

[Gp IIb/IIIa receptor antagonists in acute coronary syndromes with no ST elevation].

Authors
  • Decalf, V1
  • Sabbah, L
  • Lafont, A
  • Danchin, N
  • Durand, E
  • 1 Faculté de médecine, Hôpital européen Georges-Pompidou, service de cardiologie, université Paris-Descartes.
Type
Published Article
Journal
Archives des maladies du coeur et des vaisseaux
Publication Date
December 2007
Volume
100
Issue
12
Pages
1006–1012
Identifiers
PMID: 18223514
Source
Medline
License
Unknown

Abstract

Gp IIb/IIIa receptor antagonists have been the subject of much work in patients presenting with acute coronary syndrome with no ST elevation (ACS ST-). The initial studies (PRISM, PRISM-PLUS, PURSUIT, PARAGON, CAPTURE, GUSTO IV-ACS) were performed at the end of the 1990s and universally showed a significant reduction in an endpoint combining death and myocardial infarction, especially in patients with an elevation of troponin and treated by angioplasty. However, these studies were performed at a time when clopidogrel was not being used regularly for this indication. Four randomised studies have recently re-evaluated the significance of Gp IIb/IIIa blockers prescribed either on admission to coronary intensive care (ELISA-2, PRACTICE) or in the coronary angiography suite during angioplasty (ADVANCE, ISAR-REACT 2) in patients presenting with ACS ST- pre-treated with clopidogrel in association with aspirin and heparin. The results of these studies suggest that Gp IIb/IIIa blockers initiated at the start of angioplasty significantly reduce an endpoint combining death, myocardial infarction and the need for emergency revascularisation. On the other hand, studies in which Gp IIb/IIIa blockers are initiated in coronary intensive care have been negative, but they have only been carried out on small numbers. The results of the ACUITY study comparing bivalirudin and Gp IIb/IIIa blockers in this context have recently been published. Bivalirudin seems to compare well with Gp IIb/IIIa blockers in terms of ischemia, but it significantly reduces the occurrence of hemorrhagic events.

Report this publication

Statistics

Seen <100 times