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

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.

• Authors: V Decalf, L Sabbah, A Lafont, N Danchin, E Durand
• Journal: Archives des maladies du coeur et des vaisseaux (Arch Mal Coeur Vaiss) Vol. 100 Issue 12 Pg. 1006-12 (Dec 2007) ISSN: 0003-9683 [Print] France
• Vernacular Title: Antagonistes des récepteurs Gp IIb/IIIa dans les syndromes coronaires aigus sans sus décalage du segment ST.
• PMID: 18223514 (Publication Type: Journal Article, Review)

Chemical References

• Anticoagulants
• Hirudins
• Peptide Fragments
• Platelet Aggregation Inhibitors
• Platelet Glycoprotein GPIIb-IIIa Complex
• Recombinant Proteins
• Troponin T
• Clopidogrel
• Ticlopidine
• bivalirudin

Topics

• Acute Coronary Syndrome (therapy)
• Angioplasty, Balloon, Coronary
• Anticoagulants (therapeutic use)
• Clopidogrel
• Hirudins
• Humans
• Myocardial Infarction (prevention & control)
• Myocardial Revascularization
• Peptide Fragments (therapeutic use)
• Platelet Aggregation Inhibitors (therapeutic use)
• Platelet Glycoprotein GPIIb-IIIa Complex (antagonists & inhibitors)
• Premedication
• Recombinant Proteins (therapeutic use)
• Ticlopidine (analogs & derivatives, therapeutic use)
• Troponin T (blood)