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糖蛋白 IIb/IIIa 抑制剂作为抗血小板药物的更新综述:基础与临床观点。

An Updated Review on Glycoprotein IIb/IIIa Inhibitors as Antiplatelet Agents: Basic and Clinical Perspectives.

机构信息

Facultad de Medicina, Universidad del Azuay, Cuenca, Ecuador.

V.I. Nikitin Chemistry Institute of the National Academy of Sciences of Tajikistan, Ayni 299/2, 734063, Dushanbe, Tajikistan.

出版信息

High Blood Press Cardiovasc Prev. 2023 Mar;30(2):93-107. doi: 10.1007/s40292-023-00562-9. Epub 2023 Jan 13.

Abstract

The glycoprotein (GP) IIb/IIIa receptor is found integrin present in platelet aggregations. GP IIb/IIIa antagonists interfere with platelet cross-linking and platelet-derived thrombus formation through the competition with fibrinogen and von Willebrand factor. Currently, three parenteral GP IIb/IIIa competitors (tirofiban, eptifibatide, and abciximab) are approved for clinical use in patients affected by percutaneous coronary interventions (PCI) in the location of acute coronary syndrome (ACS). GP IIb/IIIa antagonists have their mechanism of action in platelet aggregation prevention, distal thromboembolism, and thrombus formation, whereas the initial platelet binding to damage vascular areas is preserved. This work is aimed to provide a comprehensive review of the significance of GP IIb/IIIa inhibitors as a sort of antiplatelet agent. Their mechanism of action is based on factors that affect their efficacy. On the other hand, drugs that inhibit GP IIb/IIIa already approved by the FDA were reviewed in detail. Results from major clinical trials and regulatory practices and guidelines to deal with GP IIb/IIIa inhibitors were deeply investigated. The cardiovascular pathology and neuro-interventional surgical application of GP IIb/IIIa inhibitors as a class of antiplatelet agents were developed in detail. The therapeutic risk/benefit balance of currently available GP IIb/IIa receptor antagonists is not yet well elucidated in patients with ACS who are not clinically evaluated regularly for early cardiovascular revascularization. On the other hand, in patients who have benefited from PCI, the antiplatelet therapy intensification by the addition of a GP IIb/IIIa receptor antagonist (intravenously) may be an appropriate therapeutic strategy in reducing the occurrence of risks of thrombotic complications related to the intervention. Development of GP IIb/IIIa inhibitors with oral administration has the potential to include short-term antiplatelet benefits compared with intravenous GP IIb/IIIa inhibitors for long-term secondary preventive therapy in cardiovascular disease. But studies showed that long-term oral administration of GP IIb/IIIa receptor inhibitors has been ineffective in preventing ischemic events. Paradoxically, they have been linked to a high risk of side effects by producing prothrombotic and pro-inflammatory events.

摘要

糖蛋白(GP)IIb/IIIa 受体是血小板聚集中存在的整合素。GP IIb/IIIa 拮抗剂通过与纤维蛋白原和血管性血友病因子竞争,干扰血小板交联和血小板衍生的血栓形成。目前,三种静脉内 GP IIb/IIIa 竞争抑制剂(替罗非班、依替巴肽和阿昔单抗)已获准用于临床治疗急性冠状动脉综合征(ACS)部位经皮冠状动脉介入治疗(PCI)的患者。GP IIb/IIIa 拮抗剂的作用机制是预防血小板聚集、远端血栓栓塞和血栓形成,而初始血小板与损伤血管区域的结合则得以保留。这项工作旨在全面回顾 GP IIb/IIIa 抑制剂作为一种抗血小板药物的重要性。它们的作用机制基于影响其疗效的因素。另一方面,详细审查了已获得 FDA 批准的抑制 GP IIb/IIIa 的药物。深入研究了主要临床试验和监管实践以及处理 GP IIb/IIIa 抑制剂的指南的结果。详细阐述了 GP IIb/IIIa 抑制剂作为一类抗血小板药物在心血管病理和神经介入手术中的应用。在未定期进行早期心血管血运重建临床评估的 ACS 患者中,目前可用的 GP IIb/IIa 受体拮抗剂的治疗风险/获益平衡尚未得到充分阐明。另一方面,对于已从 PCI 中受益的患者,通过添加 GP IIb/IIIa 受体拮抗剂(静脉内)来强化抗血小板治疗可能是一种适当的治疗策略,可降低与介入相关的血栓并发症风险。与静脉内 GP IIb/IIIa 抑制剂相比,具有口服给药的 GP IIb/IIIa 抑制剂的开发具有潜在的短期抗血小板益处,可用于心血管疾病的长期二级预防治疗。但研究表明,长期口服 GP IIb/IIIa 受体抑制剂在预防缺血事件方面无效。矛盾的是,它们通过产生促血栓形成和促炎事件与副作用高风险相关联。

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