A systematic review update of the clinical effectiveness and cost-effectiveness of glycoprotein IIb/IIIa antagonists
Robinson M, Ginnelly L, Sculpher M, Jones L, Riemsma R, Palmer S, Philips Z, Glanville J
Record ID 32003000411
English
Authors' objectives:
This systematic review focuses on the use of glycoprotein IIb/IIIa antagonists (GPAs) in three indications: - as part of the medical management of non-ST-elevation acute coronary syndrome (ACS) in conjunction with aspirin and heparin - as an adjunct to percutaneous coronary intervention (PCI) in various groups of patients - as a supplement to thrombolytic therapy in patients with acute myocardial infarction (AMI).
Reviews of the effectiveness and cost-effectiveness of GPAs for the first two indications are an update on those undertaken for the National Institute for Clinical Excellence (NICE) in 2000.
Authors' recommendations:
The following conclusions may be drawn from the update:
- the effectiveness of GPAs as adjuncts to percutaneous coronary intervention (PCI) is further confirmed by additional large studies showing similar effect sizes and bleeding rates
- there is no evidence for the clinical superiority of tirofiban or eptifibatide over abciximab; drug costs of the newer agents are somewhat lower, however
- the evidence that GPAs are effective in non-ST-elevation ACS in situations when PCI is not undertaken is weakened by the publication of the GUSTO IV-ACS study; however, a recent meta-analysis of individual patient data from all major trials including GUSTO IV-ACS showed a small overall effect in such patients
- based on current evidence, it may be considered that the extra benefits of GPAs adjunctive to thrombolysis in AMI are not justified by the risks of extra bleeding.
Authors' methods:
Systematic review
Details
Project Status:
Completed
URL for project:
http://www.hta.ac.uk/1262
Year Published:
2002
English language abstract:
An English language summary is available
Publication Type:
Not Assigned
Country:
England, United Kingdom
MeSH Terms
- Costs and Cost Analysis
- Coronary Disease
- Platelet Aggregation Inhibitors
- Platelet Glycoprotein GPIIb-IIIa Complex
Contact
Organisation Name:
NIHR Health Technology Assessment programme
Contact Address:
NIHR Journals Library, National Institute for Health and Care Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK
Contact Name:
journals.library@nihr.ac.uk
Contact Email:
journals.library@nihr.ac.uk
Copyright:
2009 Queen's Printer and Controller of HMSO
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