Results of a meta-analysis in this week’s issue of THE LANCET lend further support to the benefits of the anti-clotting drugs glycoprotein IIb/IIIa inhibitors for the treatment of patients with acute coronary syndromes. However, an unexpected finding of the study suggests that men might be more likely to benefit from therapy with this class of drugs.
Platelet glycoprotein IIb/IIIa inhibitors are a class of drugs which prevent blood clotting in the coronary arteries; they have been shown to reduce cardiac complications in patients undergoing percutaneous coronary intervention (PCI; balloon angioplasty or coronary stenting). However, The value of these drugs in patients with acute coronary syndromes who did not have PCI is uncertain.
Eric Boersma from University Hospital Rotterdam, The Netherlands, and colleagues pooled data from six previously published trials which involved a total of around 31,400 patients from 41 countries. 30 days after randomisation, 3530 (11%) of patients died or had a myocardial infarction (heart attack). Patients randomised to receive a glycoprotein IIb/IIIa inhibitor were 9% less likely to die or to have a myocardial infarction compared with patients given placebo or control medication.
Unexpectedly, men given glycoprotein IIb/IIIa inhibitors had a 19% reduction in the risk of death or myocardial infarction within 30 days compared with placebo or control; by contrast, treatment effect was compatible with a 15% risk increase among women. The relative treatment benefit was similar in subgroups of patients according to important clinical baseline characteristics—the absolute treatment benefit was therefore largest in high-risk patients. Major bleeding complications were slightly increased in patients given glycoprotein IIb/IIIa inhibitors (2.4% compared with 1.4%).
Eric Boersma comments: “Glycoprotein IIb/IIIa inhibitors reduce the occurrence of death or myocardial infarction in patients with acute coronary syndromes not routinely scheduled for early revascularisation. The event reduction is greatest in patients at high risk of thrombotic complications. Treatment with a glycoprotein IIb/IIIa inhibitor might therefore be considered especially in such patients early after admission, and continued until a decision about early coronary revascularisation has been made.”
Contact: Dr Eric Boersma, University Hospital Rotterdam, Department of cardiology Room H543, DR.M olewaterplein 40, 3015 GD Rotterdam, Netherlands; T) +31 10 463 3909; F) +31 10 408 9484; E) boersma@thch.azr.nl
Journal
The Lancet