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Glycoprotein IIb/IIIa inhibitors still add benefit in elective PCI

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Even with routine use of stents and thienopyridines such as clopidogrel for elective percutaneous coronary intervention, glycoprotein IIb/IIIa inhibitors (GPIs) such as abciximab still provide additional benefit.

That’s according to the findings of a meta-analysis reported in the March 8 issue of the Journal of the American College of Cardiology by Dr. Anthony A. Bavry and colleagues at the University of Florida in Gainesville.

The authors note that studies have shown GPIs to be useful during PCI, but much of this research was done before coronary stents and thienopyridines were used routinely. Currently, there is disagreement about the value of GPIs during elective PCI.

To investigate, they identified 22 studies with 10,123 patients undergoing elective PCI with stenting and thienopyridines in which the patients were randomized to a GPI versus a placebo or usual care.

“Nonfatal MI at 30 days was reported for all but 2 trials,” the investigators report. “The incidence of MI was 5.1% with GPI and 8.3% with control (RR: 0.66; p<0.0001).” However, all-cause mortality within 30 days was not significantly different; 0.3% with GPI versus 0.5% with control (RR: 0.70; p=0.27). The authors had hypothesized that bleeding complications would be higher with GPI use. They found that the incidence of major bleeding was not increased significantly (1.2% with GPI versus 0.9% with control, p=0.22), while the incidence of minor bleeding was significantly higher with a GPI (3.0%) than without (1.7%; p<0.0001). “Overall, the use of GPIs during elective modern PCI seems to be safe and effective,” Dr. Bavry and colleagues conclude. The results “reminds us not to discard older drugs simply because they are older,” writes Dr. Deepak Bhatt of Brigham and Women’s Hospital and Harvard Medical School, Boston, in an editorial. “Notably, this data set further validates the concept that additional platelet inhibition is warranted beyond that provided by aspirin and standard-dose thienopyridines. J Am Coll Cardiol 2011;57:1190–1199.