Authors' objectives:

This report is an evaluation of the role and choice of glycoprotein IIb/IIIa inhibitors during percutaneous coronary interventions (PCI) at the MUHC.

Authors' results and conclusions: Glycoprotein IIbIIIa (GP2b3a) inhibitors are powerful anti-platelet medications which have been studied in over 18,000 patients undergoing PCI. At present, 3 GP2b3a inhibitors (abciximab, eptifibatide, tirofiban) have been extensively studied against placebo and all are approved for use in Canada and are on the MUHC formulary. Abciximab was the first studied and the majority of the published reports have concerned this drug. Not surprisingly, this has become the standard GP3b2a drug used at the MUHC. There has been only one comparative study between these drugs, abciximab versus tirofiban. The short term (30 day) results of this study demonstrated the superiority of abciximab in reducing non-fatal myocardial infarctions (no difference in mortality or the need for urgent revascularizations). However, by 6 months there were no differences in clinical outcomes. Moreover, a recent placebo controlled trial with eptifibatide showed similar reductions in adverse outcomes as seen with abciximab. Finally acute coronary syndrome patients admitted, and not proceeding directly to PCI, have demonstrated similar benefits with tirofiban and eptifibatide but surprisingly not with abciximab.

Authors' recommendations: Based on the synthesis of all available information, this evaluation concludes that there is probable therapeutic equivalence between the GP 2b3a inhibitor drugs. Given the incremental cost associated with abciximab, the TAU Committee recommends the following: Routine use of GP 2b3a inhibitors during PCI is not recommended in the MUHC catheterization laboratories. Rather, treatment should be reserved for high-risk patients as defined by clinical and angiographic assessments. Since there are no clinically meaningful differences in outcomes between the different agents, in most cases the lower priced agents, tirofiban or eptifibatide, should be favored. It is nevertheless recognized that the more expensive agent, abciximab, may be the preferred drug for certain specific clinical indications.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.mcgill.ca/tau/publications/2002

Year Published: 2002

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Canada

Organisation Name: Technology Assessment Unit of the McGill University Health Centre (MUHC)

Contact Address: Technology Assessment Unit of the MUHC, Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, 5252 boul. de Maisonneuve, Bureau 3F.50, Montreal, Quebec H4A 3S5

Contact Name: nandini.dendukuri@mcgill.ca

Contact Email: nandini.dendukuri@mcgill.ca

Copyright: Technology Assessment Unit of the McGill University Health Centre (MUHC)