GPIIb-IIIa Receptor Inhibitors in Acute Coronary Syndrome Patients Presenting With Cardiogenic Shock and/or After Cardiopulmonary Resuscitation

Kanic, Vojko; Vollrath, Maja; Penko, Meta; Markota, Andrej; Kompara, Gregor; Kanic, Zlatka

doi:10.1016/j.hlc.2017.02.011

Cited by 10 publications

(22 citation statements)

References 32 publications

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“…Aspirin (100 mg) indefinitely and clopidogrel (75 mg) daily for 6–12 months. Kanic et al [ 17 ] Hypotension (systolic BP < 90 mmHg for > 30 min or the need for supportive measures to maintain systolic BP > 90 mmHg) and evidence of end-organ hypoperfusion. Also included patients after CPR on admission.…”

Section: Methodsmentioning

confidence: 99%

Glycoprotein IIb/IIIa inhibitors for cardiogenic shock complicating acute myocardial infarction: a systematic review, meta-analysis, and meta-regression

et al. 2020

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Background Cardiogenic shock complicates 5–10% of myocardial infarction (MI) cases. Data about the benefit of glycoprotein IIb/IIIa inhibitors (GPI) in these patients is sparse and conflicting. Methods We performed a systematic review, meta-analysis, and meta-regression of studies assessing the impact of GPI use in the setting of MI complicated cardiogenic shock on mortality, angiographic success, and bleeding events. We systematically searched for studies comparing GPI use as adjunctive treatment versus standard care in this setting. Random-effects meta-analysis and meta-regression were performed. Results Seven studies with a total of 1216 patients (GPI group, 720 patients; standard care group, 496 patients) were included. GPI were associated with a 45% relative reduction in the odds of death at 30 days (pooled OR 0.55; 95% CI 0.35–0.85; I2 = 57%; P = 0.007) and a 49% reduction in the odds of death at 1 year (pooled OR 0.51; 95% CI 0.32–0.82; I2 = 58%; P = 0.005). Reduction in short-term mortality seemed to be more important before 2000, as this benefit disappears if only the more recent studies are analyzed. GPI were associated with a 2-fold increase in the probability of achieving TIMI 3 flow (pooled OR, 2.05; 95% CI 1.37–3.05; I2 = 37%, P = 0.0004). Major bleeding events were not increased with GPI therapy (pooled OR, 1.0; 95% CI 0.55–1.83; I2 = 1%, P = 0.99). Meta-regression identified that patients not receiving an intra-aortic balloon pump seemed to benefit the most from GPI use (Z = − 1.57, P = 0.005). Conclusion GPI therapy as an adjunct to standard treatment in cardiogenic shock was associated with better outcomes, including both short- and long-term survival, without increasing the risk of bleeding.

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Section: Methodsmentioning

confidence: 99%

Glycoprotein IIb/IIIa inhibitors for cardiogenic shock complicating acute myocardial infarction: a systematic review, meta-analysis, and meta-regression

et al. 2020

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“…In the Efficacy Study of LV Assist Device to Treat Patients with Cardiogenic Shock (ISAR‐SHOCK) registry, 42% of patients with an acute coronary syndrome and CS treated with a thienopyridine had high‐platelet reactivity 5–6 hr following the loading dose . There are only a few observational studies on clinical outcomes to guide antiplatelet selection in patients with AMICS, as summarized in Table . In the ISAR‐SHOCK registry, 30‐day mortality was significantly lower in patients treated with prasugrel compared with clopidogrel (30 vs. 50%, respectively; p = .025), without excess in bleeding ( p = .571) .…”

Section: Adjunctive Antithrombotic Pharmacotherapymentioning

confidence: 99%

“…In a post hoc analysis of the IABP‐SHOCK II trial, patients with AMICS treated with prasugrel or ticagrelor did not experience lower mortality at 1 year compared with those treated with clopidogrel (adjusted hazards ratio: 0.83; 95% CI: 0.59–1.19), and bleeding rates were similar (adjusted hazards ratio: 0.91; 95%CI: 0.55–1.5) . In a single‐center observational study ( n = 261), newer P2Y12 inhibitors (ticagrelor or prasugrel) were independently associated with lower 30‐day mortality (OR: 0.51; 95% CI: 0.27–0.98) . The scarce clinical evidence on P2Y12 inhibitors in CS is hampered by its observational nature and by limited power to detect meaningful differences in outcomes.…”

Section: Adjunctive Antithrombotic Pharmacotherapymentioning

confidence: 99%

“…In 2015, de Felice et al analyzed consecutive AMICS patients treated with primary PCI in two centers and did not identify abciximab use as an independent predictor of 1‐year mortality after propensity score multivariable adjustment (HR: 1.08; 95%CI: 0.70–1.60; p = .60) . In a subsequent single‐center retrospective study ( n = 261), patients with ACS and CS and/or resuscitated cardiac arrest treated with a GPI (eptifabitide: 163; abciximab: 7) had significantly lower rates of 30‐day mortality rates compared with those who were not, following multivariable adjustment (46.5 vs. 54.9%, respectively; p = .015) . The use of GPI was also independently associated with a lower 1‐year mortality (adjusted HR: 0.62; 95%: 0.39–0.97; p = .037).…”

Section: Adjunctive Antithrombotic Pharmacotherapymentioning

confidence: 99%

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Technical consideration in acute myocardial infarction with cardiogenic shock: A review of antithrombotic and PCI therapies

Marquis‐Gravel

Zeitouni

Kochar

et al. 2019

Cathet Cardio Intervent

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In this review, we report a contemporary appraisal of the available evidence focusing on adjunctive antithrombotic therapy and technical aspects of percutaneous coronary interventions (PCI) in patients with acute myocardial infarction and cardiogenic shock (AMICS). Only few randomized trials have been conducted to evaluate the optimal arterial access choice, antithrombotic therapy, stent type, or the role of aspiration thrombectomy in this population. Observational data suggest that a transradial approach should be preferred for experienced operators, although knowledge and experience of transfemoral access is required to place any mechanical support device.In the absence of high-quality evidence to guide choice of the adjunctive antithrombotic drugs to support PCI in patients with AMICS, knowledge of the altered pharmacokinetics and pharmacodynamics in shock is required to inform decisions.Drug-eluting stents should be favored over bare-metal stents, and routine thrombectomy is not encouraged. Owing to the challenges inherent to the conduct of randomized trials in this acutely ill patient population, concerted multicenter, and international efforts are paramount to orchestrate the development of high-quality evidence to guide clinical practice.anticoagulant, antiplatelet, aspiration thrombectomy, cardiogenic shock, percutaneous coronary intervention, radial access

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“…Similarly, an antagonist of GPIIb/IIIa can inhibit the attack of thrombotic disease and slow down tumor growth. 15 – 18 These findings imply that dual inhibitor of P-selectin and GPIIb/IIIa receptors should simultaneously inhibit arterial thrombosis, venous thrombosis, and tumor growth. In this context, the structural characteristics of the previously reported carbolines were analyzed.…”

Section: Introductionmentioning

confidence: 97%

Design and development of ICCA as a dual inhibitor of GPIIb/IIIa and P-selectin receptors

Chen

Zhang

et al. 2018

DDDT

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BackgroundThe impact of upregulation of platelet membrane glycoprotein (GP)IIb/IIIa and P-selectin on the onset of arterial thrombosis, venous thrombosis, and cancer encourages to hypothesize that dual inhibitor of GPIIb/IIIa and P-selectin receptors should simultaneously inhibit arterial thrombosis, block venous thrombosis, and slow tumor growth.MethodsFor this reason, the structural characteristics and the CDOCKER interaction energies of 12 carbolines were analyzed. This led to the design of 1-(4-isopropyl-phenyl)-β-carboline-3-carboxylic acid (ICCA) as a promising inhibitor of GPIIb/IIIa and P-selectin receptors.ResultsThe synthetic route provided ICCA in 48% total yield and 99.6% high-performance liquid chromatography purity. In vivo 5 μmol/kg oral ICCA downregulated GPIIb/IIIa and P-selectin expression thereby inhibited arterial thrombosis, blocked venous thrombosis, and slowed down tumor growth, but did not damage the kidney and the liver.ConclusionTherefore, ICCA could be a promising candidate capable of downregulating GPIIb/IIIa and P-selectin receptors, inhibiting arterial thrombosis, blocking venous thrombosis, and slowing down tumor growth.

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GPIIb-IIIa Receptor Inhibitors in Acute Coronary Syndrome Patients Presenting With Cardiogenic Shock and/or After Cardiopulmonary Resuscitation

Cited by 10 publications

References 32 publications

Glycoprotein IIb/IIIa inhibitors for cardiogenic shock complicating acute myocardial infarction: a systematic review, meta-analysis, and meta-regression

Glycoprotein IIb/IIIa inhibitors for cardiogenic shock complicating acute myocardial infarction: a systematic review, meta-analysis, and meta-regression

Technical consideration in acute myocardial infarction with cardiogenic shock: A review of antithrombotic and PCI therapies

Design and development of ICCA as a dual inhibitor of GPIIb/IIIa and P-selectin receptors

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