The benefits of abciximab questioned in percutaneous coronary interventions following pretreatment with high-dose clopidogrel

Abstract

Dual antiplatelet therapy with aspirin and clopidogrel have significantly reduced early complications and improved the long-term outcome following coronary stent placement, and have become standard therapies for the prevention of subacute stent thrombosis. Intravenous glycoprotein (GP) IIb/IIIa inhibitors further prevent periprocedural thrombotic complications in patients undergoing percutaneous coronary interventions (PCI), especially in high-risk patients including those with diabetes mellitus and elevated cardiac markers. However, it was unclear whether, and to what extent, additional benefit could be obtained from the administration of GP IIb/IIIa inhibitors to patients in whom clopidogrel-induced inhibition of platelet aggregation is maximal. The ISAR-REACT trial enrolled patients with coronary artery disease at low risk undergoing elective PCI, wheras the second trial (ISAR-SWEET) focussed on diabetic patients with coronary artery disease undergoing elective PCI. Both trials were conducted to evaluate the benefits of the GP IIb/IIIa abciximab in patients undergoing PCI and pretreated with a high loading dose of clopidogrel. Overall, there was no added benefit from abciximab in the patients under study. Although these trials cast significant doubts over the benefits of abciximab in low- and intermediate-risk patients undergoing PCI, including diabetics, abciximab remains an important therapeutic option for the prevention of complications in high-risk patients pending further evidencefrom further study.

• abciximab
• antiplatelet therapy
• clopidogrel
• glycoprotein IIb/IIIa inhibitors
• paper evaluation
• percutaneous coronary interventions
• stent
• trials