Document Detail


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.
MedLine Citation:
PMID:  21035214     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
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.
Authors:
Alessandro Sciahbasi; Giuseppe Biondi-Zoccai; Enrico Romagnoli; Marco Valgimigli; Saman Rasoul; Arnoud Van't Hof; Ernesto Lioy; Gregg W Stone
Related Documents :
18308454 - Reperfusion strategies in st-elevation myocardial infarction--current status and perspe...
10715254 - Aspirin use is low among united states outpatients with coronary artery disease.
373954 - Recruitment in the coronary drug project and the aspirin myocardial infarction study.
7361654 - Multiple coronary thromboses in previously normal coronary arteries: a rare cause of ac...
718764 - Immunological determination of serum m-ast activity in patients with acute myocardial i...
19371824 - Ischemia detected on continuous electrocardiography after acute coronary syndrome: obse...
Publication Detail:
Type:  Journal Article     Date:  2010-10-28
Journal Detail:
Title:  International journal of cardiology     Volume:  155     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2012 Mar 
Date Detail:
Created Date:  2012-02-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  243-8     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
Affiliation:
Policlinico Casilino-ASL RMB, Rome, Italy.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Differential effects of bundle branch block morphology in heart failure.
Next Document:  Factors associated with changes of state of foot conformation and lameness in a flock of sheep.