מתוך medicontext.co.il
NEW YORK (Reuters Health) – Glycoprotein IIb/IIIa inhibitors reduce mortality and myocardial infarction (MI) in patients with acute coronary syndromes who would not routinely undergo early revascularization, according to the results of a meta-analysis reported in The Lancet for January 19.
Dr. Eric Boersma, from University Hospital Rotterdam, the Netherlands, and colleagues analyzed randomized clinical trials that included patients who had acute coronary syndromes without ST-segment elevation. Each trial included at least 1915 patients and compared glycoprotein IIb/IIIa inhibitor use with placebo or control therapy.
The six trials that met the study criteria included 31,402 patients. Pooled analysis showed that by 30 days after being randomized 11.2% of the patients had died or had had an MI.
Among patients receiving glycoprotein IIb/IIIa inhibitors, at 30 days, the odds ratio for death and MI was 0.91 compared with patients receiving control medications or placebo (p = 0.015), the researchers found. The greatest benefit from glycoprotein IIb/IIIa inhibitor therapy was seen among the highest risk patients, they add.
There was a gender-dependent difference seen in treatment effect. The odds ratio for death or MI within 30 days for men receiving glycoprotein IIb/IIIa inhibitors was 0.81, but for women it was 1.15 (p = 0.015). However, when patients were stratified by troponin concentrations, the gender difference disappeared, Dr. Boersma's team notes.
Patients receiving glycoprotein IIb/IIIa inhibitors had more major bleeding complications compared with patients receiving control medications or placebo (2.4% versus 1.4% respectively, p < 0.0001), although intracranial bleeding was similar in the treatment groups (0.09% versus 0.06%, p = 0.40), the researchers found.
Dr. Boersma and colleagues conclude that "in a cost-cautious environment, treatment with a glycoprotein IIb/IIIa inhibitor might therefore be considered early after admission in high-risk patients, and continued until a decision about whether to revascularize has been made."
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