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THE JOURNAL OF CARDIOVASCULAR SURGERY

A Journal on Cardiac, Vascular and Thoracic Surgery


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The Journal of Cardiovascular Surgery 1999 August;40(4):505-16

Copyright © 2000 EDIZIONI MINERVA MEDICA

language: English

Inhibitors of the platelet receptor glycoprotein IIb-IIIa and complications during percutaneous coronary revascularization. Management strategies for the cardiac surgeon

Dyke C., Bhatia D.*

From the Carolinas Heart Institute and Heineman Medical Research Institute *Cardiothoracic Surgery Resident Carolinas Medical Center Charlotte, North Carolina, USA


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Platelet-medi­at­ed throm­bo­sis has a piv­ot­al ­role in the pathoph­y­sio­lo­gy of ­acute ischem­ic cor­o­nary syn­dromes (­AICS) and the ­acute com­pli­ca­tions of per­cut­ane­ous cor­o­nary inter­ven­tions. Because ­cross-link­ing of the acti­vat­ed plate­let recep­tor gly­co­pro­tein (GP) IIb-IIIa by plas­ma fibrino­gen rep­re­sents the ­final com­mon path­way to cor­o­nary throm­bus for­ma­tion, sev­er­al GP IIb-IIIa inhib­i­tors ­have ­been devel­oped as a poten­tial­ly ­more effec­tive anti­throm­bot­ic ther­a­py ­than ­agents cur­rent­ly ­used for ­this pur­pose, name­ly aspi­rin and hep­ar­in. However, use of GP IIb-IIIa inhib­i­tors in ­patients ­with ­AICS and ­those sched­uled for per­cut­ane­ous cor­o­nary inter­ven­tions may ­increase the ­risk of seri­ous clin­i­cal and bleed­ing ­events ­among ­patients who ­require emer­gen­cy or ­urgent ­bypass sur­gery. This ­review ­describes clin­i­cal expe­ri­ence ­with var­i­ous GP IIb-IIIa inhib­i­tors and sug­gests man­age­ment strat­e­gies for ­patients under­go­ing emer­gen­cy or ­urgent ­bypass sur­gery short­ly ­after treat­ment ­with GP IIb-IIIa inhib­i­tors.

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