1. C-3. Clinical trial updates: GP IIb/IIIa inhibitors
Proposed model for optimal use of GP IIb/IIIa inhibitors
Content Points:
The clinical efficacy of GP IIb/IIIa inhibitors is related to the level of platelet inhibition.1 Maximum efficacy at time of PCI occurs when >80% inhibition is achieved.
However, prolonged exposure to lesser levels of platelet inhibition in the absence of early revascularization may induce platelet P-selectin expression, thereby enhancing inflammation.
This model suggests that exposure to low levels of platelet inhibition (as occurred during trials of oral GP IIb/IIIa inhibitors) or use of suboptimal intravenous (IV) doses may be proinflammatory and prothrombotic.
1 Quinn MJ, Plow EF, Topol EJ. Platelet glycoprotein IIb/IIIa inhibitors: Recognition of a two-edged sword? Circulation. 2002;106:

2. GP IIb/IIIa inhibitors: Benefit related to revascularization strategy
Content Points:
Roffi et al performed a meta-analysis of randomized trials of GP IIb/IIIa inhibitors in patients with non-ST-elevation ACS.1
As shown, they found that patients undergoing PCI while receiving a GP IIb/IIIa inhibitor derived significant benefit. Patients who underwent PCI following discontinuation of a GP IIb/IIIa inhibitor derived a lesser benefit, which did not reach statistical significance. Patients who were managed medically without an interventional procedure derived only marginal benefit.
1 Roffi M, Chew DP, Mukherjee D, Bhatt DL, White JA, Moliterno DJ, et al. Platelet glycoprotein IIb/IIIa inhibition in acute coronary syndromes. Gradient of benefit related to the revascularization strategy. Eur Heart J. 2002;23:

3. GP IIb/IIIa inhibitors: Events prevented and number-needed-to-treat
by management strategy
Content Points:
Antman1 used the data from Roffi et al2 (discussed on the previous slide) to quantify the treatment effects of GP IIb/IIIa inhibitors according to revascularization strategy.
The number of events (death or MI) prevented per 1000 patients treated:
Patients undergoing PCI while receiving a GP IIb/IIIa inhibitor: 30
Patients who undergo PCI following discontinuation of a GP IIb/IIIa inhibitor: 14
Patients who are managed medically: 4
The number of patients needed to treat to prevent one event (death or MI):
Patients undergoing PCI while receiving a GP IIb/IIIa inhibitor: 32
Patients who undergo PCI following discontinuation of a GP IIb/IIIa inhibitor: 71
Patients who are managed medically: 250
1 Antman EM. 'I can see clearly now': A new view on the use of IV GP IIb/IIIa inhibitors in acute coronary syndromes. Eur Heart J. 2002;23:
2 Roffi M, Chew DP, Mukherjee D, Bhatt DL, White JA, Moliterno DJ, et al. Platelet glycoprotein IIb/IIIa inhibition in acute coronary syndromes. Gradient of benefit related to the revascularization strategy. Eur Heart J. 2002;23: