GP Ilb/IIIa inhibitors

Abciximab is a first-line GP Ilb/IIIa inhibitor for patients undergoing primary PCI who have not received fibrinolytics. It should not be administered to STE ACS patients who will not be undergoing PCI. 

GP Ilb/IIIa inhibitors may increase the risk of bleeding, especially if given in the setting of recent (<4 hours) administration of fibrinolytic therapy. An immune-mediated thrombocytopenia occurs in about 5% of patients. 

No concomittant GP lib-ilia inhibitors use Concomittant GP Ilb-IIIa inhibitors use... 

Abciximab STEMI (27), unstable angina (28),elective PCI (29) 0.25mg/kg followed by 0.125 xg/kg/min infusion Benefit in low/intermediate risk patients following clopidogrel pretreatment debated (39,40) Significant benefit (27-29) especially with respect to mortality (27) and reinfarction (27,28) Increased risk of major bleeding and thrombocytopenia compared to other Gp Ilb/IIIa inhibitors (33)... 

CcHnbination modalities for die mangmiait of arterial and venous thrombosis are currently being explored. While these modalities provide an increase in the efficacy, safety considerations are of cmcial importance. Aspirin is commonly used with various anticoagulants. Many other antiplatelet drugs, such as ticlopidine, are also being combined with heparin, himdin, GP Ilb/IIIa inhibitors and aspirin itself... 

Peter K, Straub A, Kohler B, et al. Platelet activation as a potential mechanism of GP Ilb/IIIa inhibitor-induced thrombocytopenia. Am J Cardiol 1999 84 519-524. 

The data for the use of GP Ilb/IIIa inhibitors in conjunction with lAT are even more scant and are limited to case reports [18-23]. Deshmukh et al reported on 21 patients with large vessel occlusion refractory to lAT with rt-PA who were treated with IV and/or lA abcix-imab, eptifibatide, or tirofiban [20]. Twelve patients received IV rt-PA and 18 underwent balloon angioplasty. Complete or partial recanalization was achieved in 17/21 patients. Three patients (14%) had asymptomatic ICH, but there were no cases of sICH. Mangiafico et al described 21 stroke patients treated with IV tirofiban and heparin followed by lA urokinase. Nineteen of these patients also underwent balloon angioplasty. TIMI 2-3 flow was achieved in 17/21 patients. ICH occurred in 5/21 patients (3 sICH and 2 SAH) and was fatal in three patients [23]. Qureshi et al described the use of IA reteplase and intravenous abciximab on 20 stroke patients [22]. There was one sICH. Partial or complete recanalization occurred in 13/20 patients. Conversely, the use of abciximab was predictive of asymptomatic SAH (OR 19.2) in nine patients who received this drug as a study protocol violation in the Multi-MERCI Part 1 trial [24]. 

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