Lepor Norman E
Cedars-Sinai Medical Center, Los Angeles, California, USA.
Rev Cardiovasc Med. 2002;3 Suppl 1:S3-S12.
Percutaneous coronary interventions (PCIs) with intravenous platelet glycoprotein (GP) IIb/IIIa receptor inhibitors have become the standard of care within the higher-risk population of patients with acute coronary syndromes. Three U.S. Food and Drug Administration-approved GP IIb/IIIa inhibitors are available in the marketplace-abciximab (ReoPro), tirofiban (Aggrastat), and eptifibatide (Integrelin)-and a fourth remains in clinical trials (lamifiban). The existence of a "class effect" among all the GP IIb/IIIa receptor inhibitors is hotly debated, but the variance of effectiveness seen even among the small-molecule drugs argues against the "class effect." In patients with acute coronary syndromes, the superiority of the large molecule, abciximab, over the small molecule, tirofiban, has been shown. In diabetic patients with acute coronary syndromes, abciximab is the only GP IIb/IIIa receptor inhibitor to provide a significant mortality advantage in patients undergoing PCI. Abciximab is also the only agent where clinical data support safety in patients with chronic renal insufficiency
在急性冠脉综合征的高危患者群体中，经皮冠状动脉介入治疗（PCI）联合静脉使用血小板糖蛋白（GP）IIb/IIIa受体抑制剂已成为治疗的标准方法。美国食品药品监督管理局批准的三种GP IIb/IIIa抑制剂已投放市场——阿昔单抗（ReoPro）、替罗非班（Aggrastat）和依替巴肽（Integrilin）——还有第四种仍在临床试验中（拉米非班）。所有GP IIb/IIIa受体抑制剂之间是否存在“类效应”存在激烈争论，但即使在小分子药物中观察到的疗效差异也反驳了“类效应”的观点。在急性冠脉综合征患者中，已证明大分子药物阿昔单抗优于小分子药物替罗非班。在患有急性冠脉综合征的糖尿病患者中，阿昔单抗是唯一一种在接受PCI治疗的患者中具有显著降低死亡率优势的GP IIb/IIIa受体抑制剂。阿昔单抗也是唯一一种临床数据支持其对慢性肾功能不全患者安全性的药物。
