Author Affiliations: Gill Heart Institute and
Division of Cardiovascular Medicine, University of Kentucky, Lexington.
Antiplatelet agents—aspirin, thienopyridines, and glycoprotein
IIb/IIIa (GpIIb/IIIa) inhibitors—have become cornerstones in the treatment
of ischemic heart disease for patients with acute coronary syndrome (ACS)
and for those undergoing percutaneous coronary intervention (PCI). Depending
on the clinical scenario and the concomitant anticoagulants used, regimens
combining 2 or more of these antiplatelet agents have resulted in fewer ischemic
events and sometimes more bleeding events compared with aspirin alone. In
patients with ST-segment elevation myocardial infarction (STEMI), aspirin
has been shown to safely reduce mortality vs placebo,1 and
it therefore serves a foundational role in thrombolytic therapy regimens.
The addition of the most potent platelet aggregation inhibitors, GpIIb/IIIa
receptor antagonists, to thrombolytic therapy (aspirin, heparin, and a fibrinolytic
agent) in STEMI patients has not resulted in lower mortality rates but has
reduced reinfarction rates. A meta-analysis of randomized trials testing abciximab
(a GpIIb/IIIa inhibitor) among 23 166 STEMI patients receiving thrombolytic
therapy reported 30-day mortality rates of 5.8% for both the abciximab and
control groups, whereas the respective rates of reinfarction were 2.3% and
3.6% (odds ratio [OR], 0.64; P<.001).2 Offsetting this benefit, however, abciximab was associated
with a higher rate of major bleeding complications (5.2% vs 3.1%; OR, 1.77; P<.001).
Moliterno DJ, Steinhubl SR. Clopidogrel for Percutaneous Coronary RevascularizationTime for More Pretreatment, Retreatment, or Both?. JAMA. 2005;294(10):1271-1273. doi:10.1001/jama.294.10.1271