Thombocytopenia selleck chemicals llc was increased eightfold with GP IIbIIIb based triple therapy in elective PCI patients. Absolute event rates Absolute event rates for composite vascular event, major bleeding and minor bleeding are shown in Figure 5. The number of patients benefiting from triple antiplatelet therapy was much larger than the number suffering from major bleeding. Discussion The premise of this systematic review was that if two antiplatelet agents are usually superior to one, then three might be better still. Multiple trials were identified which included different groups of patients and add on drugs. The results confirmed that triple antiplatelet therapy involving the addition of an intravenous GPIIbIIIa receptor antagonist is more effective than dual therapy in reducing vascular events and MI in patients Inhibitors,Modulators,Libraries with NSTE ACS or STEMI.

Death was also reduced in those with STEMI. Interestingly, the rela tive reduction in events appears to be greater in patients with STEMI than NSTE ACS. A non significant trend towards a reduction in vascular outcomes was Inhibitors,Modulators,Libraries also found in elective PCI patients when treated with a GPIIbIIIa receptor antagonist, a finding also reported in one other systematic review. In contrast, triple antiplatelet ther apy based on oral cilostazol had no effect on vascular out comes in STEMI and elective PCI patients. Similar results were noted for clopidogrel based triple therapy Inhibitors,Modulators,Libraries although this assessment was based on few patients and may reflect a type II error. Previous meta analysis involving the addition of iv GPIIbIIIa inhibitors in the setting of STEMI has revealed conflicting results.

One meta analysis involving six STEMI trials showed no significant reduction Inhibitors,Modulators,Libraries in death or recurrent MI. Another showed abciximab as an adjunctive therapy to STEMI patients undergoing stent implantation reduced mor tality and recurrent MI. A third meta analysis involv ing patients with STEMI undergoing primary angioplasty found that, combined reduced dose thrombolytic therapy and GPIIbIIIa inhibitors was not superior to Gp IIb IIIa inhibitors alone. A fourth meta analysis involving five STEMI trials showed that the use of abciximab in pri mary stenting may reduce death or MI in patients with out preprocedural thienopyridine therapy. The present meta analysis revealed that the addition of iv GPIIbIIIa inhibitors in the treatment of STEMI patients reduces death, MI and composite vascular outcome.

However, Inhibitors,Modulators,Libraries the analysis did not include the effects of GPIIbIIIa inhibi tors among different revascularization therapies of STEMI patients. Unsurprisingly, bleeding events tended to be higher in patients receiving triple antiplatelet therapy although only the analyses involving a GPIIbIIIa receptor antago nist were associated with significant increases in minor bleeding, this being present in patients with chemical information STEMI and elective PCI. Supporting this observation was a need for more blood transfusions in elective PCI.