Management of Patients With Acute Coronary Syndromes in the United States by Platelet Glycoprotein IIb/IIIa Inhibition

Lincoff, A. Michael; Harrington, Robert A.; Califf, Robert M.; Hochman, Judith S.; Guerci, Alan D.; Ohman, E. Magnus; Pepine, Carl J.; Kopecky, Steven L.; Kleiman, Neal S.; Pacchiana, Cynthia M.; Berdan, Lisa G.; Kitt, Michael M.; Simoons, Maarten L.; Topol, Eric J.

doi:10.1161/01.cir.102.10.1093

Cited by 57 publications

(6 citation statements)

References 12 publications

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“…Efficacy in the initial trial IMPACT II, of 4010 patients, was disappointing 104 but in subsequent trials, PURSUIT (10 948 patients) and ESPRIT (2064 patients), using higher doses of eptifibatide, mortality was reduced by 25% to 35% in the eptifibatide-treated group compared with the placebo groups and only a modest increase in bleeding was observed. 105–109 FDA approval was gained for eptifibatide in 1998 for treatment of ACS patients, including patients who were being managed medically and those undergoing PCI. Subsequent trials, such as PRIDE continued to optimize the dose of eptifibatide.…”

Section: Eptifibatide (Integrilin)mentioning

confidence: 99%

Integrin αIIbβ3

Błędzka

Smyth

Plow

2013

Circulation Research

138

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From the initial description of platelets in 1882, their propensity to aggregate and to contribute to thrombosis was apparent. Indeed, excessive platelet aggregation is associated with myocardial infarction and other thrombotic diseases whereas Glanzmann thrombasthenia, in which platelet aggregation is reduced, is a bleeding syndrome. Over the last half of the 20th century, many investigators have provided insights into the cellular and molecular basis for platelet aggregation. The major membrane protein on platelets, integrin αIIbβ3, mediates this response by rapidly transiting from its resting to an activated state in which it serves as a receptor for ligands that can bridge platelets together. Monoclonal antibodies, natural products, and small peptides were all shown to inhibit αIIbβ3 dependent platelet aggregation, and these inhibitors became the forerunners of antagonists that proceeded through preclinical testing and into large patient trials to treat acute coronary syndromes, particularly in the context of percutaneous coronary interventions. Three such αIIbβ3 antagonists, abciximab, eptifibatide, and tirofiban, received Food and Drug Administration approval. Over the past 15 years, millions of patients have been treated with these αIIbβ3 antagonists and many lives have been saved by their administration. With the side effect of increased bleeding and the development of new antithrombotic drugs, the use of αIIbβ3 antagonists is waning. Nevertheless, they are still widely used for the prevention of periprocedural thrombosis during percutaneous coronary interventions. This review focuses on the biology of αIIbβ3, the development of its antagonists, and some of the triumphs and shortcomings of αIIbβ3 antagonism.

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Section: Eptifibatide (Integrilin)mentioning

confidence: 99%

Integrin αIIbβ3

Błędzka

Smyth

Plow

2013

Circulation Research

138

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“…In this United States subgroup, 35 events/1000 patients treated were averted. 37 On the other hand, the majority of patients, 25,555 (81%), in the Boersma meta-analysis did not undergo early revascularization and the reduction in death or MI (Ϫ3%) was not significant. Baseline troponin measurements were available in 16,151 patients, albeit not from all of the trials.…”

Section: Platelet Gp Iib/iiia Antagonistsmentioning

confidence: 97%

Application of Current Guidelines to the Management of Unstable Angina and Non-ST-Elevation Myocardial Infarction

Braunwald

2003

Circulation

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Abstract-Unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) is a common but heterogeneous disorder with patients exhibiting widely varying risks. Early risk stratification is at the center of the management program and can be achieved using clinical criteria and biomarkers, or a combination. In addition to anti-ischemic therapy and aspirin, the thienopyridine clopidogrel is indicated except in patients who are potential candidates for urgent coronary artery bypass grafting (CABG

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“…Unlike the latter two agents, lamifiban is not licensed for use in the UK and so was not included in the recent NICE update review. 34 However, for the purpose of the decision model it was decided (2000), 6,48 Akkerhuis (2000), 50 Dyke (2000), 51 Lincoff (2000), 52 Roe (2000), 53 Boersma (2000); 54 PRISM-PLUS: Theroux (2000); 55 The Phase II study 14 had a slightly lower validity assessment than the Phase II/III studies (PARAGON A 11 and PARAGON B 44 ). There was imbalance among the groups with regard to baseline characteristics and prognostically significant variables, which were not adjusted for in the analysis of end-points.…”

Section: Lamifibanmentioning

confidence: 99%

Cost-effectiveness of alternative strategies for the initial medical management of non-ST elevation acute coronary syndrome: systematic review and decision-analytical modelling

Robinson

Palmer²,

Sculpher³

et al. 2005

Health Technol Assess

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Management of Patients With Acute Coronary Syndromes in the United States by Platelet Glycoprotein IIb/IIIa Inhibition

Abstract: Platelet glycoprotein IIb/IIIa receptor blockade with eptifibatide reduces the incidence of death or myocardial infarction among patients treated for acute ischemic syndromes without ST-segment elevation within the United States.

Cited by 57 publications

References 12 publications

Integrin αIIbβ3

Integrin αIIbβ3

Application of Current Guidelines to the Management of Unstable Angina and Non-ST-Elevation Myocardial Infarction

Cost-effectiveness of alternative strategies for the initial medical management of non-ST elevation acute coronary syndrome: systematic review and decision-analytical modelling

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