| Routine upstream versus selective downstream administration of glycoprotein IIb/IIIa inhibitors in patients with non-ST-elevation acute coronary syndromes: A meta-analysis of randomized trials. | |
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MedLine Citation:
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PMID: 21035214 Owner: NLM Status: In-Data-Review |
Abstract/OtherAbstract:
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BACKGROUND: Glycoprotein (GP) IIb/IIIa inhibitors reduce ischemic complications in patients with non-ST-elevation acute coronary syndromes (NSTEACS) who undergo invasive procedures. However the optimal timing of therapy (upstream - at hospital admission in all patients prior to coronary catheterization, or downstream - after coronary angiography selectively in patients prior to percutaneous coronary intervention) is still debated. The aim of this meta-analysis was to compare the outcome of NSTEACS patients randomized to routine upstream versus deferred selective downstream GP IIb/IIIa inhibitors. METHODS: We scanned the literature from January 1990 to May 2009 to identify all randomized trials comparing upstream administration of GP IIb/IIIa inhibitors versus its downstream use in invasively managed NSTEACS. RESULTS: In 5 randomized trials a total of 9753 patients were randomized to upstream GP IIb/IIIa inhibitors therapy versus 9716 patients randomized to deferred selective downstream therapy. Upstream therapy was associated with reduced in-hospital or 30-day major adverse ischemic cardiac events (odds ratio=0.90 [95% confidence interval 0.82-0.98], p=0.02). However the risk of major bleeding was significantly higher with upstream therapy (odds ratio=1.35 [1.11-1.63], p=0.002). Combining ischemic and hemorrhagic events in a net clinical end-point showed no significant differences between the two approaches (odds ratio=1.01 [0.92-1.10], p=0.88). CONCLUSIONS: In conclusion early administration of GP IIb/IIIa inhibitors in NSTEACS is associated with significant reduction in ischemic events compared to a selective deferred therapy after coronary angiography. However upstream therapy is also associated with increased bleeding complications. This approach should therefore be reserved for patients at high ischemic and/or low hemorrhagic risk. |
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Authors:
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Alessandro Sciahbasi; Giuseppe Biondi-Zoccai; Enrico Romagnoli; Marco Valgimigli; Saman Rasoul; Arnoud Van't Hof; Ernesto Lioy; Gregg W Stone |
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Publication Detail:
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Type: Journal Article Date: 2010-10-28 |
Journal Detail:
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Title: International journal of cardiology Volume: 155 ISSN: 1874-1754 ISO Abbreviation: Int. J. Cardiol. Publication Date: 2012 Mar |
Date Detail:
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Created Date: 2012-02-13 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8200291 Medline TA: Int J Cardiol Country: Netherlands |
Other Details:
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Languages: eng Pagination: 243-8 Citation Subset: IM |
Copyright Information:
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Copyright © 2010 Elsevier Ireland Ltd. All rights reserved. |
Affiliation:
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Policlinico Casilino-ASL RMB, Rome, Italy. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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