• J Latour-Pérez, E de Miguel-Balsa, A Alcalá-López, and F J Coves-Orts.
• Servicio de Medicina Intensiva, Hospital General de Elche, Alicante. jlatour@coma.es
• Med Intensiva. 2007 Jun 1; 31 (5): 220-30.

ObjectiveTo evaluate glycoprotein IIb/IIIa inhibitors (GPIIb/IIIa inhibitors) effectiveness and safety in patients with non-ST segment elevation acute coronary syndrome (NSTEACS) or stable coronary disease referred for percutaneous coronary revascularization pre-treated with aspirin and thienopyridines by means of a systematic review.Source Of DataElectronic search using Medline, Embase, Pascal, Cochrane Library and ISI Proceedings and manual review of the articles found.Study SelectionWe included randomized controlled trials that assessed the clinical efficacy (risk of death or infarction) and safety (bleeding and thrombocytopenia) of GPIIb/IIIa inhibitors in patients pretreated with thienopyridines.Data ExtractionData were obtained by duplicate.ResultsNine randomized controlled trials (8,604 patients) were included. Addition of GPIIb/ IIIa inhibitors reduced the risk of death or myo-cardial infarction at 30 days in those trials that included patients with NSTEACS (RR 0.67; 95%CI 0.56-0.80) but not in studies that excluded NSTEACS patients (RR 1.07; 95%CI 0.75-1.53) (p test of interaction 0.0175), As a counterpart, GPIIb/ IIIa inhibitors increased the risk of bleeding and thrombocytopenia.ConclusionsUse of GPIIb/IIIa inhibitors reduces the risk of adverse cardiac events in NSTEACS patients pre-treated with aspirin and thienopyridines but increases the risk of severe bleeding and thrombocytopenia. Its utilization in stable coronary patients does not seem justified.

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