ST elevation myocardial infarction glycoprotein IIbIIIa inhibition
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| Myocardial infarction Classification and external resources | |
 | |
|---|---|
| Diagram of a myocardial infarction (2) of the tip of the anterior wall of the heart (an apical infarct) after occlusion (1) of a branch of the left coronary artery (LCA, right coronary artery = RCA). | |
| ICD-10 | I21.-I22. |
| ICD-9 | 410 |
| DiseasesDB | 8664 |
| MedlinePlus | 000195 |
| eMedicine | med/1567 emerg/327 ped/2520 |
| Cardiology Network |
 Discuss ST elevation myocardial infarction glycoprotein IIbIIIa inhibition further in the WikiDoc Cardiology Network |
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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. [1] [1]
Clinical Trial Data
Dosing
Side Effects
Guidelines (DO NOT EDIT)
Class IIa
It is reasonable to start treatment with abciximab as early as possible before primary PCI (with or without stenting) in patients with STEMI. (Level of Evidence: B)
Class IIb
Treatment with tirofiban or eptifibatide may be considered before primary PCI (with or without stenting) in patients with STEMI. (Level of Evidence: C)[1]
Combination Therapy With GP IIb/IIIa Inhibitors
Guidelines (DO NOT EDIT)
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
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)
References
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
