When Should GPIIb/IIIa Inhibition Be Initiated in NSTEACS?

A provisional, downstream strategy was associated with some excess risk for ischemia, but it significantly reduced the risk for major bleeding in a randomized trial in which delay to PCI was only about 4 hours.

Current guidelines recommend glycoprotein IIb/IIIa inhibition for invasively treated patients with non–ST-segment-elevation acute coronary syndromes (NSTEACS). Upstream initiation of GPIIb/IIIa inhibition in all high-risk NSTEACS patients in the CCU has shown ischemia-prevention advantages over a downstream strategy of pre-PCI initiation in the catheterization lab for selected patients (Journal Watch Cardiology Mar 16 2006). However, questions remain about whether the downstream strategy might provide a counterbalancing advantage in reduced bleeding complications.

ACUITY is an open-label, randomized trial, funded by the manufacturer of bivalirudin, in which moderate- or high-risk NSTEACS patients received heparin plus GPIIb/IIIa inhibition, …

Reviewing Author

Beat J. Meyer, MD