Efficacy and safety of glycoprotein IIb/IIIa receptor antagonists for patients undergoing percutaneous coronary intervention within twelve hours of fibrinolysis

Belle, Loïc; Fourny, Magali; Reynaud, Thomas; Hammer, Laure; Vanzetto, Gérald; Labarère, José

doi:10.1002/ccd.22825

Cited by 9 publications

(12 citation statements)

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“…The study results are congruent with previous trials reviewed by the authors, which are primarily small nonrandomized studies showing no clear benefit and potential for higher rates of major bleeding with GP IIb/IIIa receptor antagonist after fibrinolysis [8]. Additional data against the routine use of GP IIb/IIIa receptor antagonist as part of a pharmacoinvasive strategy is from the recently published GRACIA-3 trial [9].…”

supporting

confidence: 86%

“…In this issue of the journal, Belle et al [8] report on the outcomes of unselected patients undergoing PCI within 12 hr of fibrinolytic therapy according to treatment with a GP IIb/IIIa receptor antagonist. Patients included in this analysis were part of a prospective STEMI registry in the Northern Alps of France where a coordinated system of STEMI care exists.…”

mentioning

confidence: 97%

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Optimizing outcomes with a pharmacoinvasive strategy: Is there a role for glycoprotein IIb/IIIa receptor antagonists?

Abbott

Shah

2011

Cathet Cardio Intervent

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Primary percutaneous coronary intervention (PCI) for ST segment elevation myocardial infarction (STEMI) is the most advantageous reperfusion therapy, but a large number of patients worldwide do not have access to this strategy [1]. In such a setting, a pharmacoinvasive approach, with fibrinolytic therapy followed by routine transfer to a PCI capable hospital for cardiac catheterization and adjunctive PCI is superior to ischemia guided PCI in high risk patients [2][3][4]. Early studies raised concerns about performing PCI immediately after fibrinolysis, with high rates of bleeding and potential for acute vessel closure related to platelet activation from fibrinolytic therapy. However, contemporary studies with more fibrin specific thrombolytic agents, antiplatelet agents, and stents have shown that PCI can be performed safely as early as 1.6 hr after fibrinolysis [2,3,5,6]. Strong evidence exists for dual antiplatelet therapy with clopidogrel treatment at the time of fibrinolytic therapy, but the role for glycoprotein (GP) IIb/IIIa receptor antagonists after fibrinolysis remains unclear [7]. In the studies examining routine early PCI after fibrinolysis, GP IIb/IIIa receptor antagonists were recommended and commonly used, but allocation was not randomized [2,3,5,6].In this issue of the journal, Belle et al.[8] report on the outcomes of unselected patients undergoing PCI within 12 hr of fibrinolytic therapy according to treatment with a GP IIb/IIIa receptor antagonist. Patients included in this analysis were part of a prospective STEMI registry in the Northern Alps of France where a coordinated system of STEMI care exists. In total, 643 patients were analyzed, 14% (n 5 87) received a GP IIb/IIIa receptor antagonist at the discretion of the treating physicians. Although not explicitly stated, the timing of cardiac catheterization at a median time of 105 min post-fibrinolysis with tenectaplase is consistent with a routine pharmacoinvasive approach in this STEMI system. The majority of patients received acute treatment with a loading dose of a thienopyridine, and abciximab was used more often than the small molecule GP IIb/IIIa receptor antagonists. The timing of the GP IIb/IIIa receptor antagonist varied and was predominantly pre-PCI, but in 29% of patients it was not given until post-PCI or post-catheterization, which may have limited the benefits. To minimize confounding in this nonrandomized observational study, a propensity score analysis modeled with clinically relevant variables was performed. Overall, the study revealed no difference in safety or efficacy outcomes. The composite end point of all cause mortality, reinfarction, and stroke at 1 year occurred in12 and 13% of recipients and nonrecipients of a GP IIb/IIIa receptor antagonist respectively (P 5 0.74). Major bleeding rates did not statistically differ either and occurred in 4.8 and 5.1% of recipients and nonrecipients. The study was underpowered for assessment of individual endpoints including intracranial hemorrhage.This important study adds to the pau...

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supporting

confidence: 86%

mentioning

confidence: 97%

Optimizing outcomes with a pharmacoinvasive strategy: Is there a role for glycoprotein IIb/IIIa receptor antagonists?

Abbott

Shah

2011

Cathet Cardio Intervent

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“…The 6-month results showed a lower incidence of events in the treated group, with no increase in bleeding. These results have been replicated in some registries, [ 14 ] but other larger ones have found no reduction in events with abciximab when clopidogrel pretreatment was given [ 15 , 16 ]. As regards bleeding risk, whereas this is clearly increased with abciximab in some registries, [ 17 ] in others this is not the case [ 14 , 16 , 18 ].…”

Section: Discussionmentioning

confidence: 76%

“…These results have been replicated in some registries, [ 14 ] but other larger ones have found no reduction in events with abciximab when clopidogrel pretreatment was given [ 15 , 16 ]. As regards bleeding risk, whereas this is clearly increased with abciximab in some registries, [ 17 ] in others this is not the case [ 14 , 16 , 18 ]. All registries clearly demonstrate the prognostic importance of shock and of obtaining adequate flow, as well as the need to reduce bleeding complications [ 15 , 19 – 21 ]…”

Section: Discussionmentioning

confidence: 76%

Antithrombotic treatment during coronary angioplasty after failed thrombolysis: strategies and prognostic implications. Results of the RESPIRE registry

Sagredo

Arrieta

Carlos

et al. 2017

BMC Cardiovasc Disord

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BackgroundThrombolysis is still used when primary angioplasty is delayed for a long time, but 25%–30% of patients require rescue angioplasty (RA). There are no established recommendations for antithrombotic management in RA. This registry analyzes regimens for antithrombotic management.MethodsA retrospective, multicenter, observational registry of consecutive patients treated with RA at 8 hospitals. All variables were collected and follow-up took place at 6 months.ResultsThe study included 417 patients. Antithrombotic therapy in RA was: no additional drugs 22.3%, unfractionated heparin (UFH) 36.6%, abciximab 15.5%, abciximab plus UFH 10.5%, bivalirudin 5.7%, enoxaparin 4.3%, and others 4.7%. Outcomes at 6 months were: mortality 9.1%, infarction 3.3%, definite or probable stent thrombosis 4.3%, revascularization 1.9%, and stroke 0.5%. Mortality was related to cardiogenic shock, age > 75 years, and anterior location. The stent thrombosis rate was highest with bivalirudin (12.5% at 6 months). The incidence of bleeding at admission was high (14.8%), but most cases were not severe (82% BARC ≤2). Variables independently associated with bleeding were: femoral access (OR 3.30; 95% CI 1.3–8.3: p = 0.004) and post-RA abciximab infusion (OR 2.26; 95% CI 1.02–5: p = 0.04).ConclusionsAntithrombotic treatment regimens in RA vary greatly, predominant strategies consisting of no additional drugs or UFH 70 U/kg. No regimen proved predictive of mortality, but bivalirudin was related to more stent thrombosis. There was a high incidence of bleeding, associated with post-RA abciximab infusion and femoral access.

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“…The data collection methods, verification procedures, accuracy, and primary outcomes have been reported in detail elsewhere. 5,6,8,9 In this analysis, data from patients located in remote areas (> 30-minute delay between telephone call to the EMS and arrival of the ambulance; 'remote group') were compared with data from patients located close to a hospital (≤ 30-minute delay; 'local group'). Second, in remote areas, data from patients who received a PCP intervention were compared with data from patients who did not receive a PCP intervention.…”

Section: Methodsmentioning

confidence: 99%

Role of primary care physicians in treating patients with ST-segment elevation myocardial infarction located in remote areas (from the REseau Nord-Alpin des Urgences [RENAU], Network)

Yayehd

Ricard

Ageron

et al. 2014

European Heart Journal: Acute Cardiovascular Care

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Efficacy and safety of glycoprotein IIb/IIIa receptor antagonists for patients undergoing percutaneous coronary intervention within twelve hours of fibrinolysis

Abstract: In this observational cohort study of unselected patients with STEMI, the administration of glycoprotein IIb/IIIa receptor antagonists provided no additional benefit to PCI performed within 12 hr of fibrinolysis, nor did it compromise patient safety.

Cited by 9 publications

References 35 publications

Optimizing outcomes with a pharmacoinvasive strategy: Is there a role for glycoprotein IIb/IIIa receptor antagonists?

Optimizing outcomes with a pharmacoinvasive strategy: Is there a role for glycoprotein IIb/IIIa receptor antagonists?

Antithrombotic treatment during coronary angioplasty after failed thrombolysis: strategies and prognostic implications. Results of the RESPIRE registry

Role of primary care physicians in treating patients with ST-segment elevation myocardial infarction located in remote areas (from the REseau Nord-Alpin des Urgences [RENAU], Network)

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