GP IIb/IIIa inhibitors Overview 2000-2001

GP IIb-IIIa use in PCI - Free PowerPoint Slides
http://www.clinicaltrialresults.org/ua/interventional/pci_home.htm 

Meta-analysis of effectiveness and safety of abciximab versus eptifibatide or tirofiban in percutaneous coronary intervention
Brown DL, et al.
Am J Cardiol 2001;87:537-41
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11230835
Neither abciximab nor eptifibatide or tirofiban treatment resulted in reductions in mortality. Only the abciximab-treated patients had reductions in myocardial infarction (4.3% vs 8.5%). There was no effect of eptifibatide or tirofiban on myocardial infarction. Urgent revascularization was reduced in both abciximab-treated (2.7% vs 6.2%) and eptifibatide- and tirofiban-treated (4.2% vs 5.5%) groups. Only abciximab-treated patients had increased major bleeding (5.8% vs 3.8%). There was no effect of eptifibatide or tirofiban on major bleeding (5.0% vs 4.3%). Thus, significant differences exist between clinical outcomes achieved by abciximab and those achieved by eptifibatide or tirofiban following PCl procedures. Comments at http://www.theheart.org/index.cfm?doc_id=21787

TCTMD - The Great Debate Slide Sets

TCT 2001 Expert Presentations 

Can Platelet Function Testing Be Used to Guide IIb/IIIa Dosing In Patients with Ischemic Heart Disease? S. R. Steinhubl  
GP IIb/IIIa Receptor Antagonists II J. E. Tcheng  
Impact of Abciximab + Stenting, Stenting Alone and Thrombolytic Therapy on Clnica Course, Myocardial Salvage and LV Function: Early and Late Outcomes Analysis from ISAR-2 and STOP-AMI H. Schuhlen  
Interventional Pharmacology: Appropriate Selection & Utilization G. Dangas  
Other Pharmacological Agents Used in PCI Patients m. s. freed  
Overview of Oral Anti-Platelets J. E. Tcheng  
PLA2 Polymorphism and Aspirin Resistance: Implications for Pharmacotherapy P. J. Goldschmidt 
Pharmacodynamic Efficacy III: ATHENS and Munich Data G. Dangas  
Pharmacodynamics of GP IIb/IIIa Inhibitors in ACS (COMPARE and Others) - Can Differences in Platelet Inhibition Explain the Paradoxical and Inconsistent Efficacy of the Various IV and Oral Agents in ACS and PCI? W. Batchelor  
Platelet Glycoprotein IIb/IIIa Inhibitors in Interventional Cardiology G. Dangas  
Rationale Application of IIb/IIIa Inhibitors G. W. Stone  

AVAILABLE FOR SELF PACED LEARNING
Incorporating the evidence for GP IIb/IIIa inhibition in PCI
CME credit: 1 hour, category 1
Data on the management of patients with acute coronary syndromes, those undergoing PCI and those treated with medical management, continue to be at the forefront in medical literature and the lay press, and certainly were widely discussed at the ACC. From the latest "Cheney attack" to the recently reported CURE trial, questions remain in the minds of the community cardiologists about how to manage these patients.
Join Drs James Ferguson, Dean Kereiakes, Michael Lincoff, and Eric J Topol for this program.
http://www.theheart.org/index.cfm?doc_id=22690
[This activity is supported by an educational grant from Eli Lilly and Company]

ACC Current Journal Review Sep/Oct 2001
Small molecules vs. antibody IIb/IIIa receptor blockade in percutaneous coronary interventions: where is the difference?
Martin J. Quinn, Eric J. Topol
pages 63-66
Abstract | Fulltext | Journal Format-PDF (321Kb)

Point-of-care measured platelet inhibition correlates with a reduced risk of an adverse cardiac event after percutaneous coronary intervention: results of the GOLD (AU-Assessing Ultegra) multicenter study
Steinhubl SR, et al.
Circulation 2001;103:2572-8
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11382726 

Platelet Inhibition After Glycoprotein IIb/IIIa Inhibitor Therapy
Michele Galli
Circulation 2001;104 e163
http://circ.ahajournals.org/cgi/content/full/104/25/e163 

Rapid assessment of glycoprotein IIb/IIIa blockade with the platelet function analyzer (PFA-100) during percutaneous coronary intervention
Madan M, et al.
Am Heart J 2001;141:226-33
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11174336  
Comment

Administration of abciximab to patients receiving tirofiban or eptifibatide: effect on platelet function
Lev EI, et al.
J Am Coll Cardiol 2001;37:847-55
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11693761
This is the first in vivo study of combination intravenous platelet glycoprotein IIb/IIIa inhibitor therapy. Administration of abciximab immediately after tirofiban or eptifibatide therapy effectively inhibits platelet function and appears to be safe.

Defining the optimal activated clotting time during percutaneous coronary intervention: aggregate results from 6 randomized, controlled trials
Chew DP, et al.
Circulation 2001;103:961-6
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11181470 
Comment

Optimal activated clotting time during percutaneous coronary intervention
Hanratty CG, et al.
Circulation 2001;104:E83-4
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11591634 

CME Cybersession
GP IIb/IIIa inhibitors in PCI: issues of therapeutic relevance
http://cme.cybersessions.org/dukeu-port28jun00/index.html 
June 28, 2000
Drs James Tcheng (chair), Robert Harrington, and David Cohen explore the history of GP IIb/IIIa inhibitors during PCI, new developments in GP IIb/IIIa blockade and coronary stenting, and the cost-effectiveness of treatment with GP IIb/IIIa inhibitors during PCI.

CME Cybersession
Practice guidelines for the use of GP IIb/IIIa inhibitors
http://cme.cybersessions.org/dukeu-port20sep00/index.html
September 20, 2000
Drs Robert Harrington (chair), Matthew Roe, and Eugene Braunwald discuss recent advances in the treatment of patients with acute coronary syndromes and the new guidelines for the use of platelet glycoprotein IIb/IIIa inhibitors.

Guidance on the use of glycoprotein IIb/IIIa inhibitors in the treatment of acute coronary syndromes
  National Institute for Clinical Excellence
  http://www.nice.org.uk  
  Click here to view the full article
1) This guidance applies to patients with UA or non-Q-wave MI and those patients undergoing acute or elective PCI
2) For high-risk patients with UA or non-Q-wave MI the intravenous use of GP IIb/IIIa inhibitors, in addition to aspirin and low (adjusted) dose unfractionated heparin, is recommended. 
3) In UA, raised blood levels of troponin should be used to identify those at high risk 
4) For patients undergoing acute or elective PCI, the intravenous use of GP IIb/IIIa inhibitors is recommended. 

TCT 2000 Expert Presentation Slides

 AHA 2000 Meeting Coverage

Platelet glycoprotein IIb/IIIa blockade and outcome of cardiogenic shock complicating acute coronary syndromes without persistent ST- segment elevation
  Hasdai D et al.
  J Am Coll Cardiol 2000;36:685-92
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010987585
Patients with shock treated with eptifibatide had significantly reduced adjusted odds of death, suggesting a salutary effect of antiplatelet therapy on shock. This finding warrants verification in specifically designed studies. 
  Click here for comments from TCTMD.com  

Platelet glycoprotein IIb/IIIa receptor blockade in coronary artery disease
  Lincoff AM et al.
  J Am Coll Cardiol 2000;35:1103-15
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010758948
Numerous trials have proven the benefits of intravenous platelet glycoprotein IIb/IIIa antagonists for patients with coronary artery disease. 
Click here for comments at Medscape