A Cochrane review [Abstract] 1 included 60 studies with a total of 66 689 subjects. Of these, 48 trials (n=33 513) were on GP IIb/IIIa blockers administered during percutaneous coronary intervention (PCI) and 12 trials (n=33 176) tested these drugs as initial medical treatment in patients with non-ST segment elevation acute coronary syndromes (NSTEACS). For percutaneous revascularization, GP IIb/IIIa blockers decreased mortality at 30 days (OR 0.79, 95% CI 0.64 to 0.97) but not at 6 months (OR 0.90, 95% CI 0.77 to 1.05). Mortality or infarction was decreased both at 30 days (OR 0.66, 95% CI 0.60 to 0.72) and at 6 months (OR 0.75, 95% CI 0.64 to 0.86), but severe bleeding was increased (OR 1.39, 95% CI 1.21 to 1.61, absolute risk increase (ARI) 8.0 per 1000). The efficacy results were homogeneous for every endpoint according to the clinical condition of the patients, but were less marked for patients pre-treated with clopidogrel, especially in patients without acute coronary syndromes (ACS).
As initial medical treatment of NSTEACS, GP IIb/IIIa blockers were not associated with decreased mortality at 30 days (OR 0.90, 95% CI 0.79 to 1.02) or at 6 months (OR 1.00, 95% CI 0.87 to 1.15) but slightly decreased death or myocardial infarction at 30 days (OR 0.91, 95% CI 0.85 to 0.98) and at 6 months (OR 0.88, 95% CI 0.81 to 0.96), although severe bleeding was increased (OR 1.29, 95% CI 1.14 to 1.45, ARI 1.4 per 1000).
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