Glycoprotein IIb–IIIa Inhibitors for Acute Ischemic Stroke
- brain ischemia
- platelet aggregation inhibitors
- platelet glycoprotein GPIIb-IIIa complex
This is an update of a Cochrane review to assemble all the available data to evaluate the efficacy and safety of glycoprotein IIb–IIIa inhibitors in people with ischemic stroke, within 6 hours from symptoms onset.1
Glycoprotein IIb–IIIa inhibitors are potent, fast, and selective antiplatelet agents that block the final common pathway to platelet aggregation by preventing the binding of fibrinogen molecules that form bridges between adjacent platelets.
We searched the Cochrane Stroke Group trials register (last searched June 10, 2013), MEDLINE (1966 to June 2013), EMBASE (1980 to June 2013), the Cochrane Central Register of Controlled Trials (CENTRAL; The Cochrane Library, Issue 5, 2013), and major ongoing clinical trials registers (June 2013). We also searched reference lists and contacted trial authors and pharmaceutical companies.
We included 4 randomized controlled trials involving 1365 participants. Three randomized controlled trials compared the intravenous glycoprotein IIb–IIIa inhibitor abciximab with intravenous placebo (1215 participants), and 1 randomized controlled trial compared the intravenous glycoprotein IIb–IIIa inhibitor tirofiban with intravenous aspirin (150 participants). Treatment with either of these glycoprotein IIb–IIIa inhibitors did not significantly reduce long-term death or dependency (Figure 1). Abciximab was associated with a significant increase in symptomatic intracranial hemorrhage (Figure 2A), whereas the only small randomized controlled trial comparing tirofiban with aspirin showed no increased risk of bleeding complications with tirofiban (Figure 2B).
Glycoprotein IIb–IIIa inhibitors are associated with a significant risk of intracranial hemorrhage with no evidence of any reduction in death or disability in survivors. The conclusion is driven by trials of abciximab, which contributed 89% of the total number of study participants considered.
This paper is based on a Cochrane Review published in The Cochrane Library 2006, Issue 4 (see http://www.thecochranelibrary.com for information). Cochrane Reviews are regularly updated as new evidence emerges and in response to feedback, and The Cochrane Library should be consulted for the most recent version of the review.
- Received April 12, 2014.
- Revision received May 11, 2014.
- Accepted May 19, 2014.
- © 2014 American Heart Association, Inc.