Resumo

LATOUR-PEREZ, J.; MIGUEL-BALSA, E. de; ALCALA-LOPEZ, A.  e  COVES-ORTS, F. Javier. Effectiveness and safety of triple antiaggregation in patients undergoing coronary intervention. Med. Intensiva [online]. 2007, vol.31, n.5, pp.220-230. ISSN 0210-5691.

Objective. To 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 data. Electronic search using Medline, Embase, Pascal, Cochrane Library and ISI Proceedings and manual review of the articles found. Study selection. We 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 extraction. Data were obtained by duplicate. Results. Nine 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. Conclusions. Use 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.

Palavras-chave : myocardial ischemia; survival; non-ST segment elevation acute coronary syndrome; percutaneous revascularization; coronary angioplasty; clopidogrel; ticlopidine; thienopyridines; abciximab; tirofiban; eptifibatide; IIb/IIIa antagonists.