ST elevation myocardial infarction glycoprotein IIbIIIa inhibition
| Myocardial infarction | |
| ICD-10 | I21-I22 |
|---|---|
| ICD-9 | 410 |
| DiseasesDB | 8664 |
| MedlinePlus | 000195 |
| eMedicine | med/1567 emerg/327 ped/2520 |
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 Discuss ST elevation myocardial infarction glycoprotein IIbIIIa inhibition further in the WikiDoc Cardiology Network |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]
Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [3]
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Mechanism of Benefit
Administration of glycoprotein IIb/IIIa inhibitors alone for reperfusion therapy (i.e., without combining a fibrinolytic or in conjunction with PCI) is not suggested. 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 pharmacologic strategy.[1] To improve rates of achieving TIMI 3 flow by applied pharmacological reperfusion therapy, GP IIb/IIIa antagonists have been combined with fibrinolytic agents to achieve both platelet disaggregation and fibrinolysis.[2][3]
Clinical Trial Data
Dosing
Side Effects
ACC / AHA Guidelines- Glycoprotein IIb/IIIa Inhibitors (DO NOT EDIT)[4][5]
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)[4][5]
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 [6]
- The 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction [7]
- The 2009 ACC/AHA Focused update on the guidelines for STEMI and PCI[5]
References
- ↑ Holper EM, Giugliano RP, Antman EM (1999). "Glycoprotein IIb/IIIa inhibitors in acute ST segment elevation myocardial infarction". Coron. Artery Dis. 10 (8): 567–73. PMID 10599535. Unknown parameter
|month=ignored (help) - ↑ Gibson CM, Cannon CP, Murphy SA; et al. (2000). "Relationship of TIMI myocardial perfusion grade to mortality after administration of thrombolytic drugs". Circulation. 101 (2): 125–30. PMID 10637197. 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) - ↑ 4.0 4.1 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) - ↑ 5.0 5.1 5.2 {{[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)