ST elevation myocardial infarction glycoprotein IIbIIIa inhibition: Difference between revisions
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==Mechanism of Benefit== | ==Mechanism of Benefit== | ||
Among patients with ST elevation myocardial infarction, treatment with GPIIb/IIIa inhibitors has been associated with improved epicardial patency (TIMI 3 flow improves from approximately 15% to 30%) and improved myocardial perfusion on arrival to the cardiac catheterization laboratory <ref name="pmid16996831">{{cite journal |author=Gibson CM, Kirtane AJ, Murphy SA, Rohrbeck S, Menon V, Lins J, Kazziha S, Rokos I, Shammas NW, Palabrica TM, Fish P, McCabe CH, Braunwald E |title=Early initiation of eptifibatide in the emergency department before primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: results of the Time to Integrilin Therapy in Acute Myocardial Infarction (TITAN)-TIMI 34 trial |journal=[[American Heart Journal]] |volume=152 |issue=4 |pages=668–75 |year=2006 |month=October |pmid=16996831 |doi=10.1016/j.ahj.2006.06.003 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-8703(06)00521-7 |issn= |accessdate=2010-06-30}}</ref>. Despite these improved rates of flow and perfusion, the isolated use of a GP IIb/IIIa inhibitor does not restore TIMI 3 flow in a sufficient proportion of patients to make it a viable stand alone pharmacologic strategy in the absence of adjunctive PCI. To improve the rate of normal TIMI grade 3 flow on arrival to the cardiac catheterization laboratory, GP IIb/IIIa antagonists have been combined with fibrinolytic agents.<ref name="pmid10351964">{{cite journal |author=Antman EM, Giugliano RP, Gibson CM, McCabe CH, Coussement P, Kleiman NS, Vahanian A, Adgey AA, Menown I, Rupprecht HJ, Van der Wieken R, Ducas J, Scherer J, Anderson K, Van de Werf F, Braunwald E |title=Abciximab facilitates the rate and extent of thrombolysis: results of the thrombolysis in myocardial infarction (TIMI) 14 trial. The TIMI 14 Investigators |journal=[[Circulation]] |volume=99 |issue=21 |pages=2720–32 |year=1999 |month=June |pmid=10351964 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=10351964 |issn= |accessdate=2010-06-30}}</ref><ref name="pmid10859283">{{cite journal |author= |title=Trial of abciximab with and without low-dose reteplase for acute myocardial infarction. Strategies for Patency Enhancement in the Emergency Department (SPEED) Group |journal=Circulation |volume=101 |issue=24 |pages=2788–94 |year=2000 |month=June |pmid=10859283 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=10859283}}</ref> Despite the improvement in epicardial vessel patency with the combination of these agents, clinical outcomes were not meaningfully improved <ref name="pmid11425410">{{cite journal |author=Topol EJ |title=Reperfusion therapy for acute myocardial infarction with fibrinolytic therapy or combination reduced fibrinolytic therapy and platelet glycoprotein IIb/IIIa inhibition: the GUSTO V randomised trial |journal=[[Lancet]] |volume=357 |issue=9272 |pages=1905–14 |year=2001 |month=June |pmid=11425410 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0140673600050595 |issn= |accessdate=2010-06-30}}</ref> <ref name="pmid12413372">{{cite journal |author=Lincoff AM, Califf RM, Van de Werf F, Willerson JT, White HD, Armstrong PW, Guetta V, Gibler WB, Hochman JS, Bode C, Vahanian A, Steg PG, Ardissino D, Savonitto S, Bar F, Sadowski Z, Betriu A, Booth JE, Wolski K, Waller M, Topol EJ |title=Mortality at 1 year with combination platelet glycoprotein IIb/IIIa inhibition and reduced-dose fibrinolytic therapy vs conventional fibrinolytic therapy for acute myocardial infarction: GUSTO V randomized trial |journal=[[JAMA : the Journal of the American Medical Association]] |volume=288 |issue=17 |pages=2130–5 |year=2002 |month=November |pmid=12413372 |doi= |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=12413372 |issn= |accessdate=2010-06-30}}</ref>, and the combination of these agents prior to cardiac catheterization for STEMI has largely fallen out of favor. | |||
==Clinical Trial Data== | ==Clinical Trial Data== | ||
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==Dosing== | ==Dosing== | ||
Revision as of 15:40, 30 June 2010
| Myocardial infarction | |
| ICD-10 | I21-I22 |
|---|---|
| ICD-9 | 410 |
| DiseasesDB | 8664 |
| MedlinePlus | 000195 |
| eMedicine | med/1567 emerg/327 ped/2520 |
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Mechanism of Benefit
Among patients with ST elevation myocardial infarction, treatment with GPIIb/IIIa inhibitors has been associated with improved epicardial patency (TIMI 3 flow improves from approximately 15% to 30%) and improved myocardial perfusion on arrival to the cardiac catheterization laboratory [1]. Despite these improved rates of flow and perfusion, the isolated use of a GP IIb/IIIa inhibitor does not restore TIMI 3 flow in a sufficient proportion of patients to make it a viable stand alone pharmacologic strategy in the absence of adjunctive PCI. To improve the rate of normal TIMI grade 3 flow on arrival to the cardiac catheterization laboratory, GP IIb/IIIa antagonists have been combined with fibrinolytic agents.[2][3] Despite the improvement in epicardial vessel patency with the combination of these agents, clinical outcomes were not meaningfully improved [4] [5], and the combination of these agents prior to cardiac catheterization for STEMI has largely fallen out of favor.
Clinical Trial Data
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Dosing
Side Effects
ACC / AHA Guidelines- Glycoprotein IIb/IIIa Inhibitors (DO NOT EDIT)[6][7]
Class IIa
1. It is reasonable to start treatment with glycoprotein IIb/IIIa receptor antagonists (abciximab [Level of Evidence: A], tirofiban [Level of Evidence: B] or eptifibatide [Level of Evidence: B]) at the time of primary PCI (with or without stenting) in selected patients with STEMI.
Class IIb
1. The usefulness of glycoprotein IIb/IIIa receptor antagonists (as part of a preparatory pharmacological strategy for patients with STEMI before their arrival in the cardiac catheterization laboratory for angiography and PCI) is uncertain. (Level of Evidence: B)
ACC / AHA Guidelines- Combination Therapy With Glycoprotein IIb/IIIa Inhibitors (DO NOT EDIT)[6][7]
Class IIb
1. Combination pharmacological reperfusion with abciximab and half-dose reteplase or tenecteplase may be considered for prevention of reinfarction (Level of Evidence: A) and other complications of STEMI in selected patients: anterior location of MI, age less than 75 years, and no risk factors for bleeding. In two clinical trials of combination reperfusion, the prevention of reinfarction did not translate into a survival benefit at either 30 days or 1 year. (Level of Evidence: B)
2. Combination pharmacological reperfusion with abciximab and half-dose reteplase or tenecteplase may be considered for prevention of reinfarction and other complications of STEMI in selected patients: anterior location of MI, age less than 75 years, and no risk factors for bleeding in whom an early referral for angiography and PCI (i.e., facilitated PCI) is planned. (Level of Evidence: C)
Class III
1. Combination pharmacological reperfusion with abciximab and half-dose reteplase or tenecteplase should not be given to patients aged greater than 75 years because of an increased risk of ICH. (Level of Evidence: B)
Sources
- The 2004 ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction [8]
- The 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction [9]
- The 2009 ACC/AHA Focused update on the guidelines for STEMI and PCI[7]
References
- ↑ Gibson CM, Kirtane AJ, Murphy SA, Rohrbeck S, Menon V, Lins J, Kazziha S, Rokos I, Shammas NW, Palabrica TM, Fish P, McCabe CH, Braunwald E (2006). "Early initiation of eptifibatide in the emergency department before primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: results of the Time to Integrilin Therapy in Acute Myocardial Infarction (TITAN)-TIMI 34 trial". American Heart Journal. 152 (4): 668–75. doi:10.1016/j.ahj.2006.06.003. PMID 16996831. Retrieved 2010-06-30. Unknown parameter
|month=ignored (help) - ↑ Antman EM, Giugliano RP, Gibson CM, McCabe CH, Coussement P, Kleiman NS, Vahanian A, Adgey AA, Menown I, Rupprecht HJ, Van der Wieken R, Ducas J, Scherer J, Anderson K, Van de Werf F, Braunwald E (1999). "Abciximab facilitates the rate and extent of thrombolysis: results of the thrombolysis in myocardial infarction (TIMI) 14 trial. The TIMI 14 Investigators". Circulation. 99 (21): 2720–32. PMID 10351964. Retrieved 2010-06-30. Unknown parameter
|month=ignored (help) - ↑ "Trial of abciximab with and without low-dose reteplase for acute myocardial infarction. Strategies for Patency Enhancement in the Emergency Department (SPEED) Group". Circulation. 101 (24): 2788–94. 2000. PMID 10859283. Unknown parameter
|month=ignored (help) - ↑ Topol EJ (2001). "Reperfusion therapy for acute myocardial infarction with fibrinolytic therapy or combination reduced fibrinolytic therapy and platelet glycoprotein IIb/IIIa inhibition: the GUSTO V randomised trial". Lancet. 357 (9272): 1905–14. PMID 11425410. Retrieved 2010-06-30. Unknown parameter
|month=ignored (help) - ↑ Lincoff AM, Califf RM, Van de Werf F, Willerson JT, White HD, Armstrong PW, Guetta V, Gibler WB, Hochman JS, Bode C, Vahanian A, Steg PG, Ardissino D, Savonitto S, Bar F, Sadowski Z, Betriu A, Booth JE, Wolski K, Waller M, Topol EJ (2002). "Mortality at 1 year with combination platelet glycoprotein IIb/IIIa inhibition and reduced-dose fibrinolytic therapy vs conventional fibrinolytic therapy for acute myocardial infarction: GUSTO V randomized trial". JAMA : the Journal of the American Medical Association. 288 (17): 2130–5. PMID 12413372. Retrieved 2010-06-30. Unknown parameter
|month=ignored (help) - ↑ 6.0 6.1 Antman EM, Anbe DT, Armstrong PW; et al. (2004). "ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction)". Circulation. 110 (5): 588–636. doi:10.1161/01.CIR.0000134791.68010.FA. PMID 15289388. Unknown parameter
|month=ignored (help) - ↑ 7.0 7.1 7.2 {{[1]}}
- ↑ Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK (2004). "ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction)". Circulation. 110 (9): e82–292. PMID 15339869. Unknown parameter
|month=ignored (help) - ↑ Antman EM, Hand M, Armstrong PW; et al. (2008). "2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee". Circulation. 117 (2): 296–329. doi:10.1161/CIRCULATIONAHA.107.188209. PMID 18071078. Unknown parameter
|month=ignored (help)