Clinical challenges of platelet glycoprotein IIb/IIIa receptor inhibitor therapy: bleeding, reversal, thrombocytopenia, and retreatment.

Published

Journal Article (Review)

Randomized clinical trials of glycoprotein IIb/IIIa integrin inhibition during percutaneous coronary intervention and as adjunctive treatment of acute coronary syndromes have shown impressive clinical efficacy in reducing the morbidity and mortality rates of cardiovascular disease. Three agents are currently available in the United States: abciximab (ReoPro), eptifibatide (Integrilin), and tirofiban (Aggrastat). Pharmacodynamic studies show that abciximab is a high-affinity agent with a low dissociation constant; eptifibatide and tirofiban are high-specificity agents with higher dissociation constants and concentration-dependent antiplatelet effects. This article first reviews the relevant pharmacokinetic and pharmacodynamic properties of each of the agents. These principles are then applied to a discussion of the 4 primary clinical issues concerning their use: prevention of untoward bleeding, algorithms for acute reversal, recognition and treatment of thrombocytopenia, and the issue of readministration.

Full Text

Duke Authors

Cited Authors

  • Tcheng, JE

Published Date

  • February 2000

Published In

Volume / Issue

  • 139 / 2 Pt 2

Start / End Page

  • S38 - S45

PubMed ID

  • 10650315

Pubmed Central ID

  • 10650315

Electronic International Standard Serial Number (EISSN)

  • 1097-6744

International Standard Serial Number (ISSN)

  • 0002-8703

Digital Object Identifier (DOI)

  • 10.1067/mhj.2000.103742

Language

  • eng