Blood Thinners - Page 7

Super Aspirins ( Glycoprotein IIb/IIIa inhibitors)

What are super aspirins (Glycoprotein IIb/IIIa inhibitors)?
Glycoprotein (GP) IIb/IIIa inhibitors are antiplatelet medications. Antiplatelets make the blood less sticky, which helps prevent blood clots from forming. These antiplatelets are the so-called “super aspirins” because they work in a similar way to aspirin, but have a much stronger effect. Glycoprotein IIb/IIIa inhibitors are injected into the arm through an IV line. Abciximab (pronounced ab-six-i-mab, ReoPro) is one example. They should not be confused with arthritis drugs (COX inhibitors), which are sometimes called super-aspirins.

What are they used for?
These medications are mainly used in people undergoing angioplasty or stent placement. Studies show that they reduce the chances of needing another angioplasty or having a heart attack.³⁷ The super aspirins work best in patients who are high-risk, including elderly patients or people with diabetes.^{38, 39} There is no evidence that these antiplatelets reduce the chances of dying early. The evidence supporting the use of glycoprotein IIb/IIIa inhibitors comes from clinical trials, which include a carefully selected group of patients. Observational studies of “real world” patients suggest that the benefits may not be as great.⁴⁰
People with unstable angina or a mild heart attack may be treated with medications alone. Two of the super aspirins, eptifibatide (Integrilin) and tirofiban (Aggrastat), have been approved for this type of medical management of unstable angina or a mild heart attack. Although studies showed that these drugs reduce the risk of a heart attack in most of these patients, the results of one study found that eptifibatide (Integrilin) was of little or no benefit in women.⁴¹ Abciximab (ReoPro) is not used to treat unstable angina or mild heart attack by drugs alone because it was found to be of no benefit in these cases.⁴² Abciximab is used in patients with unstable angina or mild heart attack if they are likely to undergo angioplasty or stenting.

What are the risks of taking super aspirins?
As with any medication that thins the blood, super aspirins increase the risk of bleeding problems. Women treated with glycoprotein IIb/IIIa inhibitors tend to experience more bleeding complications than men.^{43 44} Abciximab (ReoPro) may also cause a dangerously low platelet count ( thrombocytopenia), but this can be treated relatively easily. The other super aspirins, eptifibatide (Integrilin) and tirofiban (Aggrastat), are much less likely to cause this side effect.^{45, 46}
In some patients treated with clot busters, the drugs don't work and patients have to undergo “rescue” angioplasty. Glycoprotein IIb/IIIa inhibitors should not be used during rescue angioplasty as they increase the risk of bleeding, especially in women and the elderly.⁴⁷
Super-aspirin antiplatelets are injected into the arm through an IV line. Some clinical trials studied the use of oral glycoprotein IIb/IIIa inhibitors. Patients took pills at home after they had a heart attack or underwent angioplasty. Unfortunately, oral glycoprotein IIb/IIIa inhibitors were found to be harmful. People who took the pills were more likely to have a heart attack or die than the people who did not take the pills.48 The oral glycoprotein IIb/IIIa inhibitors also caused severe bleeding problems. For these reasons, the pill version is no longer being studied.

<page1> <page2> <page3> <page4> <page5> <page6> <page7> <page8>