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450 Part IV / Practical Issues and Future Applications
the clinical presentation and preferred treatment strategy, clinicians can apply the available
evidence to select the appropriate agent for use (Table 2).
Unresolved issues, such as the need for therapeutic monitoring and new potential indi-
cations, mandate further clinical trials to refine the place of these agents within a treat-
ment algorithm for patients with ACS. Sufficient data to establish the use of GPIIb/IIIa
inhibitors as a standard of care exists for patients undergoing PCI and for whom PCI is
planned. Future studies will examine the role of these agents in the treatment of patients
with heart failure and other vascular disorders.
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Table 2
Authors’ Recommendations for Evidence-Based Selection of GPIIb/IIIa Antagonist
Clinical indication GPIIb/IIIa antagonist
Non-ST-segment elevation acute coronary syndromes Eptifibatide, tirofiban
Followed by early revascularization
a
Eptifibatide, tirofiban
Low-risk, elective percutaneous coronary intervention Eptifibatide, abciximab
High-risk percutaneous coronary intervention Abciximab
ST-segment elevation myocardial infarction Abciximab
a
24–48 h after initiation of GP IIb/IIIa therapy.
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Chapter 21 / Summary and the Future 451
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Chapter 21 / Summary and the Future 457
APPENDIX: LIST OF REFERENCED CLINICAL TRIALS
A to Z Aggrastat to Zocor
ADMIRAL Abciximab before Direct angioplasty and stenting in
Myocardial Infarction
Regarding Acute and Long-term follow-up
ADVANCE-MI ADdressing the Value of facilitated Angioplasty after
Combination therapy or Eptifibatide monotherapy in acute
Myocardial Infarction
ASSENT-3 ASsessment of the Safety and Efficacy of a New
Thrombolytic-3
BRAV O Blockade of the IIb/IIIa Receptor to Avoid Vascular
Occlusion
CADILLAC Controlled Abciximab and Device Investigation to Lower Late
Angioplasty Complications
CAPRIE Clopidogrel versus Aspirin in Patients at Risk of Ischemic
Events
CAPTURE Chimeric 7E3 AntiPlatelet Therapy in Unstableangina
REfractory to standard treatment
CARS Coumadin and Aspirin Reinfarction Study
COMPARE Comparison Of Measurements of Platelet aggregation with
Aggrastat, ReoPro, and Eptifibatide
CURE Clopidogrel in Unstable angina to prevent Recurrent Events
EPIC Evaluation of c7E3 for the Prevention of Ischemic
Complications
EPILOG Evaluation in PTCA to Improve Long-term Outcome with
abciximab GP IIb/IIIa blockade
EPISTENT Evaluation of Platelet Inhibition in STENTing
ESPRIT Enhanced Suppression of the Platelet IIb/IIIa Receptor with
Integrilin Therapy
ESSENCE Efficacy and Safety of Subcutaneous Enoxaparin in Non-Q
wave Coronary Events
EXCITE Evaluation of oral Xemilofiban in ControllIng Thrombotic
Events
FINESSE Facilitated InterventioN with Enhanced reperfusion Speed
to Stop Events
FRISC-II FRagmin and fast revascularization during InStability in
Coronary artery disease-II
FROST Fibrinogen Receptor Occupancy STudy
GOLD AU-Assessing Ultegra Multicenter Study
GUSTO-IIb Global Use of Strategies To Open occluded arteries in acute
coronary syndromes
GUSTO-IV, -V Global Use of Strategies To Open occluded coronary arteries
HERO-2 Hirulog and Early Reperfusion or Occlusion
HOT Hypertension Optimal Treatment
IMPACT-II Integrilin to Minimize Platelet Aggregation and Coronary
Thrombosis
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458 Part IV / Practical Issues and Future Applications
INTRO-AMI INTegrilin and Reduced dose Of thrombolytics for Acute
Myocardial Infarction
ISAR-2 Intracoronary Stenting and Antithrombotic Regimen
OASIS Organization to Assess Strategies for Ischemic Syndromes
OPUS-TIMI 16 Orbofiban in Patients with Unstable coronary Syndromes
ORBIT Oral glycoprotein IIb/IIIa Receptor Blockade to Inhibit
Thrombosis
PACT Primary Angioplasty Compatibility Trial
PAMI Primary Angioplasty in Myocardial Infarction
PARAGON Platelet IIb/IIIa Antagonists for Reduction of Acute
coronary syndrome events in a Global Organization Network
PCI-CURE Percutaneous Coronary Intervention-Clopidogrel in Unstable
angina to prevent Recurrent Events
PRISM Platelet Receptor inhibition in Ischemic Syndrome
Management
PRISM-PLUS Platelet Receptor inhibition for Ischemic Syndrome
Management in Patients Limited by Unstable Signs and
symptoms
PURSUIT Platelet glycoprotein IIb/IIIa in Unstable angina: Receptor
Suppression Using Integrilin Therapy
RAPPORT ReoPro And Primary PTCA Organization and Randomized
Trial
REPLACE-2 Randomized Evaluation in PCI Linking Angiomax to reduced
Clinical Events
RESTORE Randomized Efficacy Study of Tirofiban for Outcomes and
REstenosis
SPEED Strategies for Patency Enhancement in the Emergency
Department
STOP-AMI Stent versus Thrombolysis for Occluded coronary arteries in
Patients with Acute Myocardial Infarction
SYMPHONY Sibrafiban vs aspirin to Yield Maximum Protection from
ischemic Heart events pOst acute coroNarY syndromes
SYNERGY Superior Yield of the New strategy of Enoxaparin,
Revascularization, and GlYcoprotein IIb/IIIa Inhibitors
TACTICS-TIMI 18 Treat angina with Aggrastat and determine Cost of Therapy
with an Invasive or Conservative Strategy
TARGET do Tirofiban And ReoPro Give similar Efficacy? Trial
TIMI Thrombolysis In Myocardial Infarction
VANQWISH Veterans Affairs Non-Q-Wave Infarction Strategies in
Hospital
WARIS II Warfarin Aspirin ReInfarction Study II
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Index 459
INDEX
459
A
Abciximab,
acute myocardial infarction, percutaneous
coronary intervention and abciximab
therapy,
ADMIRAL, 280–282
CADILLAC, 281, 283
clinical outcomes, 281–283
contractile function recovery, 280
ISAR-2, 279–281
microvascular reperfusion, 278, 279
myocardial salvage, 280
prospects, 283, 284
RAPPORT, 281
rationale, 275, 276
STOP-AMI, 280
TIMI grade 3 flow establishment and
adequacy, 276, 277
antithrombin combination therapy, 348
binding affinity for glycoprotein IIb/IIIa
receptor, 84
development,
animal model studies of thrombosis,
80, 81, 106
chimeric antibody, 81
overview, 105, 106
duration of therapy, 85
economic analysis,
percutaneous coronary intervention,
CAPTURE, 312
EPIC, 309–311
EPILOG, 311, 312
EPISTENT, 312, 313
ST-elevation myocardial infarction, 317
epitope, 85, 383
evidence-based selection, 450
fibrinolysis, acute myocardial ischemia,
and glycoprotein IIb/IIIa receptor
blockade,
ASSENT-3, 298, 300
GUSTO-V, 295–297
TAMI 8, 290
low-molecular-weight heparin combination
therapy, 352, 354, 355
major adverse cardiac events, early vs
late, 386, 387
mechanisms of action,
percutaneous carotid intervention adjunctive
therapy, 400, 401
percutaneous coronary intervention trials,
EPIC,
clinical efficacy, 111, 112, 114
overview, 110, 111
safety, 114, 115
study design, 111
EPILOG,
clinical efficacy, 116, 117
overview, 115
safety, 117
study design, 115, 116
EPISTENT,
clinical efficacy, 118–120
overview, 117, 118
safety, 120
study design, 118
overview of study design, 110
phase II trials, 106, 107, 109, 110
pooled trial findings,
diabetes, 121, 122
endpoints after 30 d, 113
mortality, 120
unstable angina, 121
pharmacokinetics, 84–87, 106–110,
168, 386
receptor specificity, 82, 83, 168, 384–386
stroke risks, 410–412, 415, 416
trials, see ADMIRAL; CADILLAC;
CAPTURE; EPIC; EPILOG;
EPISTENT; GUSTO-IV; ISAR-2;
RAPPORT; TARGET
unstable angina trials, see also CAPTURE;
GUSTO-IV,
angiographic observations, 268, 269
benefits, 264, 265
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