SlideShare a Scribd company logo

Glycoprotein IIb/IIa inhibitors

•Download as PPTX, PDF•
•
S
Saurabh Patil

The document discusses glycoprotein IIb/IIIa inhibitors, which are a class of drugs that prevent platelet aggregation. It provides details on abciximab, eptifibatide, and tirofiban, which are three commonly used GP IIb/IIIa inhibitors. It compares their chemistry, dosing regimens, and plasma half-lives. The document also reviews the development and fate of various GP IIb/IIIa inhibitors, noting which passed clinical trials and were approved for use.

1 of 111
Glycoprotein IIb/IIIa inhibitors Presented by Dr. Saurabh Patil Guide Dr. Shruti Bhide Date 28th September 2019 Venue Department of Pharmacology and Therapeutics, Seth G S Medical College and KEM Hospital, Parel, Mumbai
Mr. Rana 55/M c/o substernal pain, shortness of breath since 30 mins k/c/o HTN Smoking: 10 pack years
Mr. Rana 55/M c/o substernal pain, shortness of breath since 30 mins k/c/o HTN Smoking: 10 pack years
Mr. Rana 55/M c/o substernal pain, shortness of breath since 30 mins k/c/o HTN Smoking: 10 pack years
Mr. Rana 55/M c/o substernal pain, shortness of breath since 30 mins k/c/o HTN Smoking: 10 pack years
Myocardial Infarction
IV NTG Aspirin Heparin Eptifibatide (180 mcg/kg Loading) ↓ Chest pain persists ↓ Angiography ↓ 90% LAD block ↓ Angioplasty Myocardial Infarction ✓
IV NTG Aspirin Heparin Eptifibatide (180 mcg/kg Loading) ↓ Chest pain persists ↓ Angiography ↓ 90% LAD block ↓ Angioplasty Myocardial Infarction ✓
IV NTG Aspirin Heparin Eptifibatide (180 mcg/kg Loading) ↓ Chest pain persists ↓ Angiography ↓ 90% LAD block ↓ Angioplasty Myocardial Infarction ✓
IV NTG Aspirin Heparin Eptifibatide (180 mcg/kg Loading) ↓ Chest pain persists ↓ Angiography ↓ 90% LAD block ↓ Angioplasty Myocardial Infarction ✓
IV NTG Aspirin Heparin Eptifibatide (180 mcg/kg Loading) ↓ Chest pain persists ↓ Angiography ↓ 90% LAD block ↓ Angioplasty Myocardial Infarction ✓
IV NTG Aspirin Heparin Eptifibatide (180 mcg/kg Loading) ↓ Chest pain persists ↓ Angiography ↓ 90% LAD block ↓ Angioplasty Myocardial Infarction ✓
IV NTG Aspirin Heparin Eptifibatide (180 mcg/kg Loading) ↓ Chest pain persists ↓ Angiography ↓ 90% LAD block ↓ Angioplasty Myocardial Infarction ✓ Clopidogrel during stenting ↓ Shifted to ward ↓ Hematoma at arterial access site in right thigh ↓ Stopped Eptifibatide, Pressure at hematoma site ↓ Hematoma resolved ↓ Discharged after 2 days
IV NTG Aspirin Heparin Eptifibatide (180 mcg/kg Loading) ↓ Chest pain persists ↓ Angiography ↓ 90% LAD block ↓ Angioplasty Myocardial Infarction ✓ Clopidogrel during stenting ↓ Shifted to ward ↓ Hematoma at arterial access site in right thigh ↓ Stopped Eptifibatide, Pressure at hematoma site ↓ Hematoma resolved ↓ Discharged after 2 days
IV NTG Aspirin Heparin Eptifibatide (180 mcg/kg Loading) ↓ Chest pain persists ↓ Angiography ↓ 90% LAD block ↓ Angioplasty Myocardial Infarction ✓ Clopidogrel during stenting ↓ Shifted to ward ↓ Hematoma at arterial access site in right thigh ↓ Stopped Eptifibatide Pressure at hematoma site ↓ Hematoma resolved ↓ Discharged after 2 days
IV NTG Aspirin Heparin Eptifibatide (180 mcg/kg Loading) ↓ Chest pain persists ↓ Angiography ↓ 90% LAD block ↓ Angioplasty Myocardial Infarction ✓ Clopidogrel during stenting ↓ Shifted to ward ↓ Hematoma at arterial access site in right thigh ↓ Stopped Eptifibatide, Pressure at hematoma site ↓ Hematoma resolved ↓ Discharged after 2 days
IV NTG Aspirin Heparin Eptifibatide (180 mcg/kg Loading) ↓ Chest pain persists ↓ Angiography ↓ 90% LAD block ↓ Angioplasty Myocardial Infarction ✓ Clopidogrel during stenting ↓ Shifted to ward ↓ Hematoma at arterial access site in right thigh ↓ Stopped Eptifibatide, Pressure at hematoma site ↓ Hematoma resolved ↓ Discharged after 2 days
IV NTG Aspirin Heparin Eptifibatide (180 mcg/kg Loading) ↓ Chest pain persists ↓ Angiography ↓ 90% LAD block ↓ Angioplasty Myocardial Infarction ✓ Clopidogrel during stenting ↓ Shifted to ward ↓ Hematoma at arterial access site in right thigh ↓ Stopped Eptifibatide, Pressure at hematoma site ↓ Hematoma resolved ↓ Discharged after 2 days ? ? ? ?
Kumar, V., Abbas, A. K., & Aster, J. C. (2015). Robbins and Cotran pathologic basis of disease (Ninth edition.)
Kumar, V., Abbas, A. K., & Aster, J. C. (2015). Robbins and Cotran pathologic basis of disease (Ninth edition.)
Kumar, V., Abbas, A. K., & Aster, J. C. (2015). Robbins and Cotran pathologic basis of disease (Ninth edition.) PDE cGMP Thrombin COX-1 TXA2
Kumar, V., Abbas, A. K., & Aster, J. C. (2015). Robbins and Cotran pathologic basis of disease (Ninth edition.)
2 1 3 4 5 Goodman, L. S., Brunton, L. L., Chabner, B., & Knollmann, B. C. (2011). Goodman & Gilman's pharmacological basis of therapeutics.
Platelet Aggregation Cascade
What is GP IIb/IIIa
What is GP IIb/IIIa Glycoprotein
What is GP IIb/IIIa Heterodimer Glycoprotein Golan, D. E. (2005). Principles of pharmacology: The pathophysiologic basis of drug therapy. Baltimore: Lippincott Williams & Wilkins.
What is GP IIb/IIIa Platelet
What is GP IIb/IIIa Platelet Platelet
What is GP IIb/IIIa Fibrinogen Platelet Platelet
What is GP IIb/IIIa Fibrinogen Platelet Platelet
What is GP IIb/IIIa Platelet Platelet
What is GP IIb/IIIa Fibrinogen Platelet Platelet
What is GP IIb/IIIa Platelet Platelet
What is GP IIb/IIIa Platelet Platelet Glanzmann Thrombasthenia
What is GP IIb/IIIa Skaik, Younis. (2015). Expression of the Recombinant Soluble Glycoprotein IIb: Lessons Learned and Future Directions. Global Journal of Hematology and Blood Transfusion. 2. 16-19. 10.15379/2408-9877.2015.02.02.03.
Which are GP IIb/IIIa Inhibitors?
Which are GP IIb/IIIa Inhibitors? Trigramin Barbourin Kistrin Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban Neki, N.S. (2004). Platelet Glycoprotein IIb / IIIa Receptor Inhibitors – Role in Coronary Artery Disease. JIACM 2004; 5(3): 259-65
Which are GP IIb/IIIa Inhibitors? Trigramin Barbourin Kistrin Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban
Which are GP IIb/IIIa Inhibitors? Trigramin Barbourin Kistrin Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban Synthetic Natural
Which are GP IIb/IIIa Inhibitors? Trigramin Barbourin Kistrin Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban Synthetic Natural
Which are GP IIb/IIIa Inhibitors? Trigramin Barbourin Kistrin Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban Synthetic Natural
Which are GP IIb/IIIa Inhibitors? Trigramin Barbourin Kistrin Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban Synthetic Natural
Which are GP IIb/IIIa Inhibitors? Trigramin Barbourin Kistrin Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban Synthetic Natural
Fates of GP IIb/IIIa inhibitors Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban
Fates of GP IIb/IIIa inhibitors Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban Phase I Phase II Phase III
Fates of GP IIb/IIIa inhibitors Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban Phase I Phase II Phase III ✓ ✓ ✓ ✓ ✓ Excess bleeding ✓ ✓ ✓ ✓ ✓ ✓
Fates of GP IIb/IIIa inhibitors Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban Phase I Phase II Phase III ✓ ✓ ✓ (ongoing) ✓ ✓ ✓ ✓ ✓ ✓ Excess bleeding ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
Fates of GP IIb/IIIa inhibitors Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban Phase I Phase II Phase III ✓ ✓ ✓ ✓ (ongoing) ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ No Efficacy Excess bleeding ✓ ✓ No Efficacy ✓ ✓ Excess mortality ✓ ✓ No Efficacy ✓ ✓ No Efficacy ✓ ✓ Discontinued ✓ ✓ Excess mortality
Fates of GP IIb/IIIa inhibitors Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban Phase I Phase II Phase III ✓ ✓ ✓ ✓ (ongoing) ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ No Efficacy Excess bleeding ✓ ✓ No Efficacy ✓ ✓ Excess mortality ✓ ✓ No Efficacy ✓ ✓ No Efficacy ✓ ✓ Discontinued ✓ ✓ Excess mortality 1997 1998 1998
Fates of GP IIb/IIIa inhibitors Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban 1997 1998 1998
Abciximab Eptifibatide Tirofiban
Abciximab Eptifibatide Tirofiban
Chemistry Chimeric Hybrid Murine–human MAb Fab Fragment (50,000 Daltons) Cyclic heptapeptide (800 Daltons) Synthetic nonpeptide tyrosine analogue (500 Daltons) Dosing 250 mcg/kg IV (bolus) 180 mcg/kg IV (bolus) + 190 mcg/kg IV (bolus) (after 10 mins) 25 mcg/kg IV (bolus) Abciximab Eptifibatide Tirofiban
Chemistry Chimeric Hybrid Murine–human MAb Fab Fragment (50,000 Daltons) Cyclic heptapeptide (800 Daltons) Synthetic nonpeptide tyrosine analogue (500 Daltons) Dosing 250 mcg/kg IV (bolus) + 125 mcg/kg/min (12 hr infusion) 180 mcg/kg IV (bolus) + 190 mcg/kg IV (bolus) (after 10 mins) + 2 mcg/kg/min (24 hr infusion) 25 mcg/kg IV (bolus) + 0.15 mcg/kg/min (18 hr infusion) Half life Plasma T½ 30 minutes ____________ Plasma T½ 15 mins ____________ Plasma T½ 2 hrs ____________ Abciximab Eptifibatide Tirofiban
Dosing 250 mcg/kg IV (bolus) + 125 mcg/kg/min (12 hr infusion) 190 mcg/kg IV (bolus) (after 10 mins) + 2 mcg/kg/min (24 hr infusion) 25 mcg/kg IV (bolus) + 0.15 mcg/kg/min (18 hr infusion) Half life Plasma T½ 30 minutes ____________ Platelet-bound T½ in Days Plasma T½ 15 mins ____________ Platelet-bound T ½ in Seconds Plasma T½ 2 hrs ____________ Platelet-bound T ½ in Seconds Return of platelet function 12 hrs 4 hrs 4 hrs Reversible with platelet Yes No No Abciximab Eptifibatide Tirofiban
(12 hr infusion) (24 hr infusion) (18 hr infusion) Half life Plasma T½ 30 minutes ____________ Platelet-bound T½ in Days Plasma T½ 15 mins ____________ Platelet-bound T ½ in Seconds Plasma T½ 2 hrs ____________ Platelet-bound T ½ in Seconds Return of platelet function 12 hrs 4 hrs 4 hrs Reversible with platelet transfusion Yes No No Self reversibility No Yes Yes Excretion Unknown Renal clearance Renal clearance PCI PCI Abciximab Eptifibatide Tirofiban
with platelet transfusion Yes No No Self reversibility No Yes Yes Excretion Unknown Renal clearance Renal clearance Indication PCI ACS PCI ACS ACS Contra- indication Hypersensitivity (Murine proteins) Bleeding tendency Neuraxial catheter in situ Uncontrolled Hypertension On dialysis Neuraxial catheter in situ h/o ↓ Platelets Neuraxial catheter in situ Immunogenicity Abciximab Eptifibatide Tirofiban
platelet transfusion Yes No No Self reversibility No Yes Yes Excretion Unknown Renal clearance Renal clearance Indication PCI ACS PCI ACS ACS Contra- indication Hypersensitivity (Murine proteins) Bleeding tendency Neuraxial catheter in situ Uncontrolled Hypertension On dialysis Neuraxial catheter in situ h/o ↓ Platelets Neuraxial catheter in situ Adverse Immunogenicity Bleeding Bleeding Bleeding Abciximab Eptifibatide Tirofiban
Contra- indication Bleeding tendency Neuraxial catheter in situ Hypertension On dialysis Neuraxial catheter in situ h/o ↓ Platelets Neuraxial catheter in situ Adverse effect Immunogenicity Bleeding ↓ Platelets Bradycardia Bleeding ↓ Platelets Bleeding ↓ Platelets Pleiotropic effects Binds to Vitronectin receptor - - Abciximab Eptifibatide Tirofiban
Contra- indication Bleeding tendency Neuraxial catheter in situ Hypertension On dialysis Neuraxial catheter in situ h/o ↓ Platelets Neuraxial catheter in situ Adverse effect Immunogenicity Bleeding ↓ Platelets Bradycardia Bleeding ↓ Platelets Bleeding ↓ Platelets Pleiotropic effects Binds to Vitronectin receptor - - Abciximab Eptifibatide Tirofiban Discontinue + Platelet Transfusion Tanzilli G, Sordi M, Arrivi A, Mangieri E, Scappaticci M. Acute profound abciximab induced thrombocytopenia: a correct management of a methodological error. Case Reports. 2009 Oct 5;2009(oct05 1):bcr1220081381–bcr1220081381. Discontinue + Supportive care Discontinue + Supportive care
Contra- indication Bleeding tendency Neuraxial catheter in situ Hypertension On dialysis Neuraxial catheter in situ h/o ↓ Platelets Neuraxial catheter in situ Adverse effect Immunogenicity Bleeding ↓ Platelets Bradycardia Bleeding ↓ Platelets Bleeding ↓ Platelets Pleiotropic effects Binds to Vitronectin receptor - - Abciximab Eptifibatide Tirofiban Discontinue + Platelet Transfusion Tanzilli G, Sordi M, Arrivi A, Mangieri E, Scappaticci M. Acute profound abciximab induced thrombocytopenia: a correct management of a methodological error. Case Reports. 2009 Oct 5;2009(oct05 1):bcr1220081381–bcr1220081381. Discontinue + Supportive care Discontinue + Supportive care
Contra- indication Bleeding tendency Neuraxial catheter in situ Hypertension On dialysis Neuraxial catheter in situ h/o ↓ Platelets Neuraxial catheter in situ Adverse effect Immunogenicity Bleeding ↓ Platelets Bradycardia Bleeding ↓ Platelets Bleeding ↓ Platelets Pleiotropic effects Binds to Vitronectin receptor - - Abciximab Eptifibatide Tirofiban Discontinue + Platelet Transfusion Tanzilli G, Sordi M, Arrivi A, Mangieri E, Scappaticci M. Acute profound abciximab induced thrombocytopenia: a correct management of a methodological error. Case Reports. 2009 Oct 5;2009(oct05 1):bcr1220081381–bcr1220081381. Discontinue + Supportive care Discontinue + Supportive care
Neuraxial catheter in situ Neuraxial catheter in situ Neuraxial catheter in situ Adverse effect Immunogenicity Bleeding ↓ Platelets Bradycardia Bleeding ↓ Platelets Bleeding ↓ Platelets Pleiotropic effects Binds to Vitronectin receptor - - Abciximab Eptifibatide Tirofiban Golan, D. E. (2005). Principles of pharmacology: The pathophysiologic basis of drug therapy. Baltimore: Lippincott Williams & Wilkins.
effect ↓ Platelets Bradycardia ↓ Platelets ↓ Platelets Pleiotropic effects Binds to Vitronectin receptor - - Abciximab Eptifibatide Tirofiban
effect ↓ Platelets Bradycardia ↓ Platelets ↓ Platelets Pleiotropic effects Binds to Vitronectin receptor - - Abciximab Eptifibatide Tirofiban Current Guidelines Sr. No. Drug Indication Recommendation Class 1 Use of Abciximab Primary PCI Class IIa – Level A 2 Use of Abciximab intracoronary inj. Primary PCI Class IIb – Level B
Current Guidelines Sr. No. Drug Indication Recommendation Class 1 Use of Abciximab Primary PCI Class IIa – Level A 2 Use of Abciximab intracoronary inj. Primary PCI Class IIb – Level B 3 Use of Eptifibatide / Tirofiban Primary PCI Class IIa – Level B 4 Discontinuation of GP IIb/IIIa inhibitor Before Urgent CABG Class I – Level B O’Gara P, Kushner F, Ascheim D, Casey D, Chung M, de Lemos J et al. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. Circulation. 2013;127(4).
Sr. No. Drug Indication Recommendation Class 1 Use of Abciximab Primary PCI Class IIa – Level A 2 Use of Abciximab intracoronary inj. Primary PCI Class IIb – Level B 3 Use of Eptifibatide / Tirofiban Primary PCI Class IIa – Level B 4 Discontinuation of GP IIb/IIIa inhibitor Before Urgent CABG Class I – Level B Current Guidelines
Current trends Published articles 0 20 40 60 80 100 120 “GP IIb/IIIa inhibitors”
Current trends Published articles 0 20 40 60 80 100 120 “GP IIb/IIIa inhibitors”
Current trends Published articles 0 20 40 60 80 100 120 “GP IIb/IIIa inhibitors”
Current trends Published articles
Current trends Published articles “Abciximab” 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Current trends Published articles “Eptifibatide” 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Current trends Published articles “Tirofiban” 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
“Abciximab” 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 1994 EPIC 1. Abciximab 2. Placebo 1997 EPILOG 1. Abciximab + Low dose heparin 2. Abciximab + Standard dose heparin 3. Placebo + Standard dose heparin 1997 CAPTURE 1. Abciximab 2. Placebo 1998 EPISTENT 1. Stenting + Placebo 2. Stenting + Abciximab 3. Balloon angioplasty + Abciximab 2001 GUSTO IV-ACS 1. Placebo + Aspirin + Heparin 2. Abciximab (24 h) + Aspirin + Heparin 3. Abciximab (48 h) + Aspirin + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2004 ISAR REACT 1 1. Abciximab 2. Placebo 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab
“Abciximab” 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 1994 EPIC 1. Abciximab 2. Placebo 1997 EPILOG 1. Abciximab + Low dose heparin 2. Abciximab + Standard dose heparin 3. Placebo + Standard dose heparin 1997 CAPTURE 1. Abciximab 2. Placebo 1998 EPISTENT 1. Stenting + Placebo 2. Stenting + Abciximab 3. Balloon angioplasty + Abciximab 2001 GUSTO IV-ACS 1. Placebo + Aspirin + Heparin 2. Abciximab (24 h) + Aspirin + Heparin 3. Abciximab (48 h) + Aspirin + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2004 ISAR REACT 1 1. Abciximab 2. Placebo 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab
“Abciximab” 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 1994 EPIC 1. Abciximab 2. Placebo 1997 EPILOG 1. Abciximab + Low dose heparin 2. Abciximab + Standard dose heparin 3. Placebo + Standard dose heparin 1997 CAPTURE 1. Abciximab 2. Placebo 1998 EPISTENT 1. Stenting + Placebo 2. Stenting + Abciximab 3. Balloon angioplasty + Abciximab 2001 GUSTO IV-ACS 1. Placebo + Aspirin + Heparin 2. Abciximab (24 h) + Aspirin + Heparin 3. Abciximab (48 h) + Aspirin + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2004 ISAR REACT 1 1. Abciximab 2. Placebo 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab
“Abciximab” 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 1994 EPIC 1. Abciximab 2. Placebo 1997 EPILOG 1. Abciximab + Low dose heparin 2. Abciximab + Standard dose heparin 3. Placebo + Standard dose heparin 1997 CAPTURE 1. Abciximab 2. Placebo 1998 EPISTENT 1. Stenting + Placebo 2. Stenting + Abciximab 3. Balloon angioplasty + Abciximab 2001 GUSTO IV-ACS 1. Placebo + Aspirin + Heparin 2. Abciximab (24 h) + Aspirin + Heparin 3. Abciximab (48 h) + Aspirin + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2004 ISAR REACT 1 1. Abciximab 2. Placebo 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab
“Abciximab” 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 1994 EPIC 1. Abciximab 2. Placebo 1997 EPILOG 1. Abciximab + Low dose heparin 2. Abciximab + Standard dose heparin 3. Placebo + Standard dose heparin 1997 CAPTURE 1. Abciximab 2. Placebo 1998 EPISTENT 1. Stenting + Placebo 2. Stenting + Abciximab 3. Balloon angioplasty + Abciximab 2001 GUSTO IV-ACS 1. Placebo + Aspirin + Heparin 2. Abciximab (24 h) + Aspirin + Heparin 3. Abciximab (48 h) + Aspirin + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2004 ISAR REACT 1 1. Abciximab 2. Placebo 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab
“Abciximab” 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 1994 EPIC 1. Abciximab 2. Placebo 1997 EPILOG 1. Abciximab + Low dose heparin 2. Abciximab + Standard dose heparin 3. Placebo + Standard dose heparin 1997 CAPTURE 1. Abciximab 2. Placebo 1998 EPISTENT 1. Stenting + Placebo 2. Stenting + Abciximab 3. Balloon angioplasty + Abciximab 2001 GUSTO IV-ACS 1. Placebo + Aspirin + Heparin 2. Abciximab (24 h) + Aspirin + Heparin 3. Abciximab (48 h) + Aspirin + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2004 ISAR REACT 1 1. Abciximab 2. Placebo 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab
“Abciximab” 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 1994 EPIC 1. Abciximab 2. Placebo 1997 EPILOG 1. Abciximab + Low dose heparin 2. Abciximab + Standard dose heparin 3. Placebo + Standard dose heparin 1997 CAPTURE 1. Abciximab 2. Placebo 1998 EPISTENT 1. Stenting + Placebo 2. Stenting + Abciximab 3. Balloon angioplasty + Abciximab 2001 GUSTO IV-ACS 1. Placebo + Aspirin + Heparin 2. Abciximab (24 h) + Aspirin + Heparin 3. Abciximab (48 h) + Aspirin + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2004 ISAR REACT 1 1. Abciximab 2. Placebo 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab
“Abciximab” 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 1994 EPIC 1. Abciximab 2. Placebo 1997 EPILOG 1. Abciximab + Low dose heparin 2. Abciximab + Standard dose heparin 3. Placebo + Standard dose heparin 1997 CAPTURE 1. Abciximab 2. Placebo 1998 EPISTENT 1. Stenting + Placebo 2. Stenting + Abciximab 3. Balloon angioplasty + Abciximab 2001 GUSTO IV-ACS 1. Placebo + Aspirin + Heparin 2. Abciximab (24 h) + Aspirin + Heparin 3. Abciximab (48 h) + Aspirin + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2004 ISAR REACT 1 1. Abciximab 2. Placebo 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab
“Eptifibatide” 1997 IMPACT-II 1. Eptifibatide 2. Placebo 1998 PURSUIT 1. Eptifibatide 2. Placebo 2000 ESPRIT 1. Eptifibatide 2. Placebo 2009 EARLY-ACS 1. Eptifibatide before angiography 2. Eptifibatide after angiography 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
“Eptifibatide” 1997 IMPACT-II 1. Eptifibatide 2. Placebo 1998 PURSUIT 1. Eptifibatide 2. Placebo 2000 ESPRIT 1. Eptifibatide 2. Placebo 2009 EARLY-ACS 1. Eptifibatide before angiography 2. Eptifibatide after angiography 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
“Eptifibatide” 1997 IMPACT-II 1. Eptifibatide 2. Placebo 1998 PURSUIT 1. Eptifibatide 2. Placebo 2000 ESPRIT 1. Eptifibatide 2. Placebo 2009 EARLY-ACS 1. Eptifibatide before angiography 2. Eptifibatide after angiography 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
“Eptifibatide” 1997 IMPACT-II 1. Eptifibatide 2. Placebo 1998 PURSUIT 1. Eptifibatide 2. Placebo 2000 ESPRIT 1. Eptifibatide 2. Placebo 2009 EARLY-ACS 1. Eptifibatide before angiography 2. Eptifibatide after angiography 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
“Eptifibatide” 1997 IMPACT-II 1. Eptifibatide 2. Placebo 1998 PURSUIT 1. Eptifibatide 2. Placebo 2000 ESPRIT 1. Eptifibatide 2. Placebo 2009 EARLY-ACS 1. Eptifibatide before angiography 2. Eptifibatide after angiography 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
“Eptifibatide” 1997 IMPACT-II 1. Eptifibatide 2. Placebo 1998 PURSUIT 1. Eptifibatide 2. Placebo 2000 ESPRIT 1. Eptifibatide 2. Placebo 2009 EARLY-ACS 1. Eptifibatide before angiography 2. Eptifibatide after angiography 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
“Eptifibatide” 1997 IMPACT-II 1. Eptifibatide 2. Placebo 1998 PURSUIT 1. Eptifibatide 2. Placebo 2000 ESPRIT 1. Eptifibatide 2. Placebo 2009 EARLY-ACS 1. Eptifibatide before angiography 2. Eptifibatide after angiography 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
“Tirofiban” 1997 RESTORE 1. Tirofiban 2. Placebo 1998 PRISM 1. Tirofiban + Aspirin 2. Aspirin 1998 PRISM-PLUS 1. Tirofiban 2. Heparin 3. Tirofiban + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
“Tirofiban” 1997 RESTORE 1. Tirofiban 2. Placebo 1998 PRISM 1. Tirofiban + Aspirin 2. Aspirin 1998 PRISM-PLUS 1. Tirofiban 2. Heparin 3. Tirofiban + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
“Tirofiban” 1997 RESTORE 1. Tirofiban 2. Placebo 1998 PRISM 1. Tirofiban + Aspirin 2. Aspirin 1998 PRISM-PLUS 1. Tirofiban 2. Heparin 3. Tirofiban + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
“Tirofiban” 1997 RESTORE 1. Tirofiban 2. Placebo 1998 PRISM 1. Tirofiban + Aspirin 2. Aspirin 1998 PRISM-PLUS 1. Tirofiban 2. Heparin 3. Tirofiban + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
“Tirofiban” 1997 RESTORE 1. Tirofiban 2. Placebo 1998 PRISM 1. Tirofiban + Aspirin 2. Aspirin 1998 PRISM-PLUS 1. Tirofiban 2. Heparin 3. Tirofiban + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
“Tirofiban” 1997 RESTORE 1. Tirofiban 2. Placebo 1998 PRISM 1. Tirofiban + Aspirin 2. Aspirin 1998 PRISM-PLUS 1. Tirofiban 2. Heparin 3. Tirofiban + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Current fate Mostly replaced in practice due to other classes of drugs especially ADP receptor pathway inhibitors (Prasugrel, Ticagrelor)
OPEN HOUSE

Recommended

Translation
TranslationTranslation
Translation
Hafeezarana
 
About Ras Al Khaimah
About Ras Al KhaimahAbout Ras Al Khaimah
About Ras Al Khaimah
c j
 
Cosentini polmone bianco
Cosentini polmone biancoCosentini polmone bianco
Cosentini polmone bianco
Roberto Cosentini
 
DHT december 2021
DHT december 2021DHT december 2021
DHT december 2021
Saurabh Patil
 
Ulcerative colitis protocol presentation
Ulcerative colitis protocol presentationUlcerative colitis protocol presentation
Ulcerative colitis protocol presentation
Saurabh Patil
 
Receptor Tyrosine Kinase
Receptor Tyrosine KinaseReceptor Tyrosine Kinase
Receptor Tyrosine Kinase
Saurabh Patil
 
Drug Delivery Devices
Drug Delivery DevicesDrug Delivery Devices
Drug Delivery Devices
Saurabh Patil
 
Gender transition pharmacotherapy
Gender transition pharmacotherapyGender transition pharmacotherapy
Gender transition pharmacotherapy
Saurabh Patil
 

Recommended

Translation
TranslationTranslation
Translation
Hafeezarana
 
About Ras Al Khaimah
About Ras Al KhaimahAbout Ras Al Khaimah
About Ras Al Khaimah
c j
 
Cosentini polmone bianco
Cosentini polmone biancoCosentini polmone bianco
Cosentini polmone bianco
Roberto Cosentini
 
DHT december 2021
DHT december 2021DHT december 2021
DHT december 2021
Saurabh Patil
 
Ulcerative colitis protocol presentation
Ulcerative colitis protocol presentationUlcerative colitis protocol presentation
Ulcerative colitis protocol presentation
Saurabh Patil
 
Receptor Tyrosine Kinase
Receptor Tyrosine KinaseReceptor Tyrosine Kinase
Receptor Tyrosine Kinase
Saurabh Patil
 
Drug Delivery Devices
Drug Delivery DevicesDrug Delivery Devices
Drug Delivery Devices
Saurabh Patil
 
Gender transition pharmacotherapy
Gender transition pharmacotherapyGender transition pharmacotherapy
Gender transition pharmacotherapy
Saurabh Patil
 
The Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic PrinciplesThe Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic Principles
MedicoseAcademics
 
Histopathology of Rheumatoid Arthritis: Visual treat
Histopathology of Rheumatoid Arthritis: Visual treatHistopathology of Rheumatoid Arthritis: Visual treat
Histopathology of Rheumatoid Arthritis: Visual treat
DIVYANSHU740006
 
Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
shivalingatalekar1
 
Histololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptxHistololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptx
AyeshaZaid1
 
The Nervous and Chemical Regulation of Respiration
The Nervous and Chemical Regulation of RespirationThe Nervous and Chemical Regulation of Respiration
The Nervous and Chemical Regulation of Respiration
MedicoseAcademics
 
Journal Article Review on Rasamanikya
Journal Article Review on RasamanikyaJournal Article Review on Rasamanikya
Journal Article Review on Rasamanikya
Dr. Jyothirmai Paindla
 
Identifying Major Symptoms of Slip Disc.
Identifying Major Symptoms of Slip Disc. Identifying Major Symptoms of Slip Disc.
Identifying Major Symptoms of Slip Disc.
Gokuldas Hospital
 
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptxREGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
LaniyaNasrink
 
CBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdfCBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdf
suvadeepdas911
 
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptxVestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Dr. Rabia Inam Gandapore
 
Top Effective Soaps for Fungal Skin Infections in India
Top Effective Soaps for Fungal Skin Infections in IndiaTop Effective Soaps for Fungal Skin Infections in India
Top Effective Soaps for Fungal Skin Infections in India
SwisschemDerma
 
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxDoes Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
walterHu5
 
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấuK CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
HongBiThi1
 
Efficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in AyurvedaEfficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in Ayurveda
Dr. Jyothirmai Paindla
 
Tests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptxTests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptx
taiba qazi
 
Complementary feeding in infant IAP PROTOCOLS
Complementary feeding in infant IAP PROTOCOLSComplementary feeding in infant IAP PROTOCOLS
Complementary feeding in infant IAP PROTOCOLS
chiranthgowda16
 
Adhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.comAdhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.com
reignlana06
 
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.GawadHemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
NephroTube - Dr.Gawad
 
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
bkling
 
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
Holistified Wellness
 
2024 State of Marketing Report – by Hubspot
2024 State of Marketing Report – by Hubspot2024 State of Marketing Report – by Hubspot
2024 State of Marketing Report – by Hubspot
Marius Sescu
 
Everything You Need To Know About ChatGPT
Everything You Need To Know About ChatGPTEverything You Need To Know About ChatGPT
Everything You Need To Know About ChatGPT
Expeed Software
 

More Related Content

Recently uploaded

The Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic PrinciplesThe Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic Principles
MedicoseAcademics
 
Histopathology of Rheumatoid Arthritis: Visual treat
Histopathology of Rheumatoid Arthritis: Visual treatHistopathology of Rheumatoid Arthritis: Visual treat
Histopathology of Rheumatoid Arthritis: Visual treat
DIVYANSHU740006
 
Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
shivalingatalekar1
 
Histololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptxHistololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptx
AyeshaZaid1
 
The Nervous and Chemical Regulation of Respiration
The Nervous and Chemical Regulation of RespirationThe Nervous and Chemical Regulation of Respiration
The Nervous and Chemical Regulation of Respiration
MedicoseAcademics
 
Journal Article Review on Rasamanikya
Journal Article Review on RasamanikyaJournal Article Review on Rasamanikya
Journal Article Review on Rasamanikya
Dr. Jyothirmai Paindla
 
Identifying Major Symptoms of Slip Disc.
Identifying Major Symptoms of Slip Disc. Identifying Major Symptoms of Slip Disc.
Identifying Major Symptoms of Slip Disc.
Gokuldas Hospital
 
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptxREGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
LaniyaNasrink
 
CBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdfCBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdf
suvadeepdas911
 
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptxVestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Dr. Rabia Inam Gandapore
 
Top Effective Soaps for Fungal Skin Infections in India
Top Effective Soaps for Fungal Skin Infections in IndiaTop Effective Soaps for Fungal Skin Infections in India
Top Effective Soaps for Fungal Skin Infections in India
SwisschemDerma
 
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxDoes Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
walterHu5
 
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấuK CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
HongBiThi1
 
Efficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in AyurvedaEfficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in Ayurveda
Dr. Jyothirmai Paindla
 
Tests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptxTests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptx
taiba qazi
 
Complementary feeding in infant IAP PROTOCOLS
Complementary feeding in infant IAP PROTOCOLSComplementary feeding in infant IAP PROTOCOLS
Complementary feeding in infant IAP PROTOCOLS
chiranthgowda16
 
Adhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.comAdhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.com
reignlana06
 
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.GawadHemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
NephroTube - Dr.Gawad
 
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
bkling
 
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
Holistified Wellness
 

Recently uploaded (20)

The Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic PrinciplesThe Electrocardiogram - Physiologic Principles
The Electrocardiogram - Physiologic Principles
 
Histopathology of Rheumatoid Arthritis: Visual treat
Histopathology of Rheumatoid Arthritis: Visual treatHistopathology of Rheumatoid Arthritis: Visual treat
Histopathology of Rheumatoid Arthritis: Visual treat
 
Cardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdfCardiac Assessment for B.sc Nursing Student.pdf
Cardiac Assessment for B.sc Nursing Student.pdf
 
Histololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptxHistololgy of Female Reproductive System.pptx
Histololgy of Female Reproductive System.pptx
 
The Nervous and Chemical Regulation of Respiration
The Nervous and Chemical Regulation of RespirationThe Nervous and Chemical Regulation of Respiration
The Nervous and Chemical Regulation of Respiration
 
Journal Article Review on Rasamanikya
Journal Article Review on RasamanikyaJournal Article Review on Rasamanikya
Journal Article Review on Rasamanikya
 
Identifying Major Symptoms of Slip Disc.
Identifying Major Symptoms of Slip Disc. Identifying Major Symptoms of Slip Disc.
Identifying Major Symptoms of Slip Disc.
 
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptxREGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
REGULATION FOR COMBINATION PRODUCTS AND MEDICAL DEVICES.pptx
 
CBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdfCBL Seminar 2024_Preliminary Program.pdf
CBL Seminar 2024_Preliminary Program.pdf
 
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptxVestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
Vestibulocochlear Nerve by Dr. Rabia Inam Gandapore.pptx
 
Top Effective Soaps for Fungal Skin Infections in India
Top Effective Soaps for Fungal Skin Infections in IndiaTop Effective Soaps for Fungal Skin Infections in India
Top Effective Soaps for Fungal Skin Infections in India
 
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxDoes Over-Masturbation Contribute to Chronic Prostatitis.pptx
Does Over-Masturbation Contribute to Chronic Prostatitis.pptx
 
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấuK CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
K CỔ TỬ CUNG.pdf tự ghi chép, chữ hơi xấu
 
Efficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in AyurvedaEfficacy of Avartana Sneha in Ayurveda
Efficacy of Avartana Sneha in Ayurveda
 
Tests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptxTests for analysis of different pharmaceutical.pptx
Tests for analysis of different pharmaceutical.pptx
 
Complementary feeding in infant IAP PROTOCOLS
Complementary feeding in infant IAP PROTOCOLSComplementary feeding in infant IAP PROTOCOLS
Complementary feeding in infant IAP PROTOCOLS
 
Adhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.comAdhd Medication Shortage Uk - trinexpharmacy.com
Adhd Medication Shortage Uk - trinexpharmacy.com
 
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.GawadHemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
Hemodialysis: Chapter 4, Dialysate Circuit - Dr.Gawad
 
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
Part II - Body Grief: Losing parts of ourselves and our identity before, duri...
 
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptx
 

Featured

2024 State of Marketing Report – by Hubspot
2024 State of Marketing Report – by Hubspot2024 State of Marketing Report – by Hubspot
2024 State of Marketing Report – by Hubspot
Marius Sescu
 
Everything You Need To Know About ChatGPT
Everything You Need To Know About ChatGPTEverything You Need To Know About ChatGPT
Everything You Need To Know About ChatGPT
Expeed Software
 
Product Design Trends in 2024 | Teenage Engineerings
Product Design Trends in 2024 | Teenage EngineeringsProduct Design Trends in 2024 | Teenage Engineerings
Product Design Trends in 2024 | Teenage Engineerings
Pixeldarts
 
How Race, Age and Gender Shape Attitudes Towards Mental Health
How Race, Age and Gender Shape Attitudes Towards Mental HealthHow Race, Age and Gender Shape Attitudes Towards Mental Health
How Race, Age and Gender Shape Attitudes Towards Mental Health
ThinkNow
 
AI Trends in Creative Operations 2024 by Artwork Flow.pdf
AI Trends in Creative Operations 2024 by Artwork Flow.pdfAI Trends in Creative Operations 2024 by Artwork Flow.pdf
AI Trends in Creative Operations 2024 by Artwork Flow.pdf
marketingartwork
 
Skeleton Culture Code
Skeleton Culture CodeSkeleton Culture Code
Skeleton Culture Code
Skeleton Technologies
 
PEPSICO Presentation to CAGNY Conference Feb 2024
PEPSICO Presentation to CAGNY Conference Feb 2024PEPSICO Presentation to CAGNY Conference Feb 2024
PEPSICO Presentation to CAGNY Conference Feb 2024
Neil Kimberley
 
Content Methodology: A Best Practices Report (Webinar)
Content Methodology: A Best Practices Report (Webinar)Content Methodology: A Best Practices Report (Webinar)
Content Methodology: A Best Practices Report (Webinar)
contently
 
How to Prepare For a Successful Job Search for 2024
How to Prepare For a Successful Job Search for 2024How to Prepare For a Successful Job Search for 2024
How to Prepare For a Successful Job Search for 2024
Albert Qian
 
Social Media Marketing Trends 2024 // The Global Indie Insights
Social Media Marketing Trends 2024 // The Global Indie InsightsSocial Media Marketing Trends 2024 // The Global Indie Insights
Social Media Marketing Trends 2024 // The Global Indie Insights
Kurio // The Social Media Age(ncy)
 
Trends In Paid Search: Navigating The Digital Landscape In 2024
Trends In Paid Search: Navigating The Digital Landscape In 2024Trends In Paid Search: Navigating The Digital Landscape In 2024
Trends In Paid Search: Navigating The Digital Landscape In 2024
Search Engine Journal
 
5 Public speaking tips from TED - Visualized summary
5 Public speaking tips from TED - Visualized summary5 Public speaking tips from TED - Visualized summary
5 Public speaking tips from TED - Visualized summary
SpeakerHub
 
ChatGPT and the Future of Work - Clark Boyd
ChatGPT and the Future of Work - Clark Boyd ChatGPT and the Future of Work - Clark Boyd
ChatGPT and the Future of Work - Clark Boyd
Clark Boyd
 
Getting into the tech field. what next
Getting into the tech field. what next Getting into the tech field. what next
Getting into the tech field. what next
Tessa Mero
 
Google's Just Not That Into You: Understanding Core Updates & Search Intent
Google's Just Not That Into You: Understanding Core Updates & Search IntentGoogle's Just Not That Into You: Understanding Core Updates & Search Intent
Google's Just Not That Into You: Understanding Core Updates & Search Intent
Lily Ray
 
How to have difficult conversations
How to have difficult conversations How to have difficult conversations
How to have difficult conversations
Rajiv Jayarajah, MAppComm, ACC
 
Introduction to Data Science
Introduction to Data ScienceIntroduction to Data Science
Introduction to Data Science
Christy Abraham Joy
 
Time Management & Productivity - Best Practices
Time Management & Productivity - Best PracticesTime Management & Productivity - Best Practices
Time Management & Productivity - Best Practices
Vit Horky
 
The six step guide to practical project management
The six step guide to practical project managementThe six step guide to practical project management
The six step guide to practical project management
MindGenius
 
Beginners Guide to TikTok for Search - Rachel Pearson - We are Tilt __ Bright...
Beginners Guide to TikTok for Search - Rachel Pearson - We are Tilt __ Bright...Beginners Guide to TikTok for Search - Rachel Pearson - We are Tilt __ Bright...
Beginners Guide to TikTok for Search - Rachel Pearson - We are Tilt __ Bright...
RachelPearson36
 

Featured (20)

2024 State of Marketing Report – by Hubspot
2024 State of Marketing Report – by Hubspot2024 State of Marketing Report – by Hubspot
2024 State of Marketing Report – by Hubspot
 
Everything You Need To Know About ChatGPT
Everything You Need To Know About ChatGPTEverything You Need To Know About ChatGPT
Everything You Need To Know About ChatGPT
 
Product Design Trends in 2024 | Teenage Engineerings
Product Design Trends in 2024 | Teenage EngineeringsProduct Design Trends in 2024 | Teenage Engineerings
Product Design Trends in 2024 | Teenage Engineerings
 
How Race, Age and Gender Shape Attitudes Towards Mental Health
How Race, Age and Gender Shape Attitudes Towards Mental HealthHow Race, Age and Gender Shape Attitudes Towards Mental Health
How Race, Age and Gender Shape Attitudes Towards Mental Health
 
AI Trends in Creative Operations 2024 by Artwork Flow.pdf
AI Trends in Creative Operations 2024 by Artwork Flow.pdfAI Trends in Creative Operations 2024 by Artwork Flow.pdf
AI Trends in Creative Operations 2024 by Artwork Flow.pdf
 
Skeleton Culture Code
Skeleton Culture CodeSkeleton Culture Code
Skeleton Culture Code
 
PEPSICO Presentation to CAGNY Conference Feb 2024
PEPSICO Presentation to CAGNY Conference Feb 2024PEPSICO Presentation to CAGNY Conference Feb 2024
PEPSICO Presentation to CAGNY Conference Feb 2024
 
Content Methodology: A Best Practices Report (Webinar)
Content Methodology: A Best Practices Report (Webinar)Content Methodology: A Best Practices Report (Webinar)
Content Methodology: A Best Practices Report (Webinar)
 
How to Prepare For a Successful Job Search for 2024
How to Prepare For a Successful Job Search for 2024How to Prepare For a Successful Job Search for 2024
How to Prepare For a Successful Job Search for 2024
 
Social Media Marketing Trends 2024 // The Global Indie Insights
Social Media Marketing Trends 2024 // The Global Indie InsightsSocial Media Marketing Trends 2024 // The Global Indie Insights
Social Media Marketing Trends 2024 // The Global Indie Insights
 
Trends In Paid Search: Navigating The Digital Landscape In 2024
Trends In Paid Search: Navigating The Digital Landscape In 2024Trends In Paid Search: Navigating The Digital Landscape In 2024
Trends In Paid Search: Navigating The Digital Landscape In 2024
 
5 Public speaking tips from TED - Visualized summary
5 Public speaking tips from TED - Visualized summary5 Public speaking tips from TED - Visualized summary
5 Public speaking tips from TED - Visualized summary
 
ChatGPT and the Future of Work - Clark Boyd
ChatGPT and the Future of Work - Clark Boyd ChatGPT and the Future of Work - Clark Boyd
ChatGPT and the Future of Work - Clark Boyd
 
Getting into the tech field. what next
Getting into the tech field. what next Getting into the tech field. what next
Getting into the tech field. what next
 
Google's Just Not That Into You: Understanding Core Updates & Search Intent
Google's Just Not That Into You: Understanding Core Updates & Search IntentGoogle's Just Not That Into You: Understanding Core Updates & Search Intent
Google's Just Not That Into You: Understanding Core Updates & Search Intent
 
How to have difficult conversations
How to have difficult conversations How to have difficult conversations
How to have difficult conversations
 
Introduction to Data Science
Introduction to Data ScienceIntroduction to Data Science
Introduction to Data Science
 
Time Management & Productivity - Best Practices
Time Management & Productivity - Best PracticesTime Management & Productivity - Best Practices
Time Management & Productivity - Best Practices
 
The six step guide to practical project management
The six step guide to practical project managementThe six step guide to practical project management
The six step guide to practical project management
 
Beginners Guide to TikTok for Search - Rachel Pearson - We are Tilt __ Bright...
Beginners Guide to TikTok for Search - Rachel Pearson - We are Tilt __ Bright...Beginners Guide to TikTok for Search - Rachel Pearson - We are Tilt __ Bright...
Beginners Guide to TikTok for Search - Rachel Pearson - We are Tilt __ Bright...
 

Glycoprotein IIb/IIa inhibitors

  • 1. Glycoprotein IIb/IIIa inhibitors Presented by Dr. Saurabh Patil Guide Dr. Shruti Bhide Date 28th September 2019 Venue Department of Pharmacology and Therapeutics, Seth G S Medical College and KEM Hospital, Parel, Mumbai
  • 2. Mr. Rana 55/M c/o substernal pain, shortness of breath since 30 mins k/c/o HTN Smoking: 10 pack years
  • 3. Mr. Rana 55/M c/o substernal pain, shortness of breath since 30 mins k/c/o HTN Smoking: 10 pack years
  • 4. Mr. Rana 55/M c/o substernal pain, shortness of breath since 30 mins k/c/o HTN Smoking: 10 pack years
  • 5. Mr. Rana 55/M c/o substernal pain, shortness of breath since 30 mins k/c/o HTN Smoking: 10 pack years
  • 7. IV NTG Aspirin Heparin Eptifibatide (180 mcg/kg Loading) ↓ Chest pain persists ↓ Angiography ↓ 90% LAD block ↓ Angioplasty Myocardial Infarction ✓
  • 8. IV NTG Aspirin Heparin Eptifibatide (180 mcg/kg Loading) ↓ Chest pain persists ↓ Angiography ↓ 90% LAD block ↓ Angioplasty Myocardial Infarction ✓
  • 9. IV NTG Aspirin Heparin Eptifibatide (180 mcg/kg Loading) ↓ Chest pain persists ↓ Angiography ↓ 90% LAD block ↓ Angioplasty Myocardial Infarction ✓
  • 10. IV NTG Aspirin Heparin Eptifibatide (180 mcg/kg Loading) ↓ Chest pain persists ↓ Angiography ↓ 90% LAD block ↓ Angioplasty Myocardial Infarction ✓
  • 11. IV NTG Aspirin Heparin Eptifibatide (180 mcg/kg Loading) ↓ Chest pain persists ↓ Angiography ↓ 90% LAD block ↓ Angioplasty Myocardial Infarction ✓
  • 12. IV NTG Aspirin Heparin Eptifibatide (180 mcg/kg Loading) ↓ Chest pain persists ↓ Angiography ↓ 90% LAD block ↓ Angioplasty Myocardial Infarction ✓
  • 13. IV NTG Aspirin Heparin Eptifibatide (180 mcg/kg Loading) ↓ Chest pain persists ↓ Angiography ↓ 90% LAD block ↓ Angioplasty Myocardial Infarction ✓ Clopidogrel during stenting ↓ Shifted to ward ↓ Hematoma at arterial access site in right thigh ↓ Stopped Eptifibatide, Pressure at hematoma site ↓ Hematoma resolved ↓ Discharged after 2 days
  • 14. IV NTG Aspirin Heparin Eptifibatide (180 mcg/kg Loading) ↓ Chest pain persists ↓ Angiography ↓ 90% LAD block ↓ Angioplasty Myocardial Infarction ✓ Clopidogrel during stenting ↓ Shifted to ward ↓ Hematoma at arterial access site in right thigh ↓ Stopped Eptifibatide, Pressure at hematoma site ↓ Hematoma resolved ↓ Discharged after 2 days
  • 15. IV NTG Aspirin Heparin Eptifibatide (180 mcg/kg Loading) ↓ Chest pain persists ↓ Angiography ↓ 90% LAD block ↓ Angioplasty Myocardial Infarction ✓ Clopidogrel during stenting ↓ Shifted to ward ↓ Hematoma at arterial access site in right thigh ↓ Stopped Eptifibatide Pressure at hematoma site ↓ Hematoma resolved ↓ Discharged after 2 days
  • 16. IV NTG Aspirin Heparin Eptifibatide (180 mcg/kg Loading) ↓ Chest pain persists ↓ Angiography ↓ 90% LAD block ↓ Angioplasty Myocardial Infarction ✓ Clopidogrel during stenting ↓ Shifted to ward ↓ Hematoma at arterial access site in right thigh ↓ Stopped Eptifibatide, Pressure at hematoma site ↓ Hematoma resolved ↓ Discharged after 2 days
  • 17. IV NTG Aspirin Heparin Eptifibatide (180 mcg/kg Loading) ↓ Chest pain persists ↓ Angiography ↓ 90% LAD block ↓ Angioplasty Myocardial Infarction ✓ Clopidogrel during stenting ↓ Shifted to ward ↓ Hematoma at arterial access site in right thigh ↓ Stopped Eptifibatide, Pressure at hematoma site ↓ Hematoma resolved ↓ Discharged after 2 days
  • 18. IV NTG Aspirin Heparin Eptifibatide (180 mcg/kg Loading) ↓ Chest pain persists ↓ Angiography ↓ 90% LAD block ↓ Angioplasty Myocardial Infarction ✓ Clopidogrel during stenting ↓ Shifted to ward ↓ Hematoma at arterial access site in right thigh ↓ Stopped Eptifibatide, Pressure at hematoma site ↓ Hematoma resolved ↓ Discharged after 2 days ? ? ? ?
  • 19. Kumar, V., Abbas, A. K., & Aster, J. C. (2015). Robbins and Cotran pathologic basis of disease (Ninth edition.)
  • 20. Kumar, V., Abbas, A. K., & Aster, J. C. (2015). Robbins and Cotran pathologic basis of disease (Ninth edition.)
  • 21. Kumar, V., Abbas, A. K., & Aster, J. C. (2015). Robbins and Cotran pathologic basis of disease (Ninth edition.) PDE cGMP Thrombin COX-1 TXA2
  • 22. Kumar, V., Abbas, A. K., & Aster, J. C. (2015). Robbins and Cotran pathologic basis of disease (Ninth edition.)
  • 23. 2 1 3 4 5 Goodman, L. S., Brunton, L. L., Chabner, B., & Knollmann, B. C. (2011). Goodman & Gilman's pharmacological basis of therapeutics.
  • 25.
  • 26.
  • 27.
  • 28.
  • 29.
  • 30.
  • 31.
  • 32.
  • 33.
  • 34.
  • 35.
  • 36. What is GP IIb/IIIa
  • 37. What is GP IIb/IIIa Glycoprotein
  • 38. What is GP IIb/IIIa Heterodimer Glycoprotein Golan, D. E. (2005). Principles of pharmacology: The pathophysiologic basis of drug therapy. Baltimore: Lippincott Williams & Wilkins.
  • 39. What is GP IIb/IIIa Platelet
  • 40. What is GP IIb/IIIa Platelet Platelet
  • 41. What is GP IIb/IIIa Fibrinogen Platelet Platelet
  • 42. What is GP IIb/IIIa Fibrinogen Platelet Platelet
  • 43. What is GP IIb/IIIa Platelet Platelet
  • 44. What is GP IIb/IIIa Fibrinogen Platelet Platelet
  • 45. What is GP IIb/IIIa Platelet Platelet
  • 46. What is GP IIb/IIIa Platelet Platelet Glanzmann Thrombasthenia
  • 47. What is GP IIb/IIIa Skaik, Younis. (2015). Expression of the Recombinant Soluble Glycoprotein IIb: Lessons Learned and Future Directions. Global Journal of Hematology and Blood Transfusion. 2. 16-19. 10.15379/2408-9877.2015.02.02.03.
  • 48. Which are GP IIb/IIIa Inhibitors?
  • 49. Which are GP IIb/IIIa Inhibitors? Trigramin Barbourin Kistrin Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban Neki, N.S. (2004). Platelet Glycoprotein IIb / IIIa Receptor Inhibitors – Role in Coronary Artery Disease. JIACM 2004; 5(3): 259-65
  • 50. Which are GP IIb/IIIa Inhibitors? Trigramin Barbourin Kistrin Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban
  • 51. Which are GP IIb/IIIa Inhibitors? Trigramin Barbourin Kistrin Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban Synthetic Natural
  • 52. Which are GP IIb/IIIa Inhibitors? Trigramin Barbourin Kistrin Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban Synthetic Natural
  • 53. Which are GP IIb/IIIa Inhibitors? Trigramin Barbourin Kistrin Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban Synthetic Natural
  • 54. Which are GP IIb/IIIa Inhibitors? Trigramin Barbourin Kistrin Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban Synthetic Natural
  • 55. Which are GP IIb/IIIa Inhibitors? Trigramin Barbourin Kistrin Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban Synthetic Natural
  • 56. Fates of GP IIb/IIIa inhibitors Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban
  • 57. Fates of GP IIb/IIIa inhibitors Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban Phase I Phase II Phase III
  • 58. Fates of GP IIb/IIIa inhibitors Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban Phase I Phase II Phase III ✓ ✓ ✓ ✓ ✓ Excess bleeding ✓ ✓ ✓ ✓ ✓ ✓
  • 59. Fates of GP IIb/IIIa inhibitors Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban Phase I Phase II Phase III ✓ ✓ ✓ (ongoing) ✓ ✓ ✓ ✓ ✓ ✓ Excess bleeding ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓
  • 60. Fates of GP IIb/IIIa inhibitors Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban Phase I Phase II Phase III ✓ ✓ ✓ ✓ (ongoing) ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ No Efficacy Excess bleeding ✓ ✓ No Efficacy ✓ ✓ Excess mortality ✓ ✓ No Efficacy ✓ ✓ No Efficacy ✓ ✓ Discontinued ✓ ✓ Excess mortality
  • 61. Fates of GP IIb/IIIa inhibitors Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban Phase I Phase II Phase III ✓ ✓ ✓ ✓ (ongoing) ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ No Efficacy Excess bleeding ✓ ✓ No Efficacy ✓ ✓ Excess mortality ✓ ✓ No Efficacy ✓ ✓ No Efficacy ✓ ✓ Discontinued ✓ ✓ Excess mortality 1997 1998 1998
  • 62. Fates of GP IIb/IIIa inhibitors Abciximab YM337 Eptifibatide Tirofiban Lamifiban Fradafiban Xemilofiban Orofiban Sibrafiban Lefradafiban Roxifiban Lotrafiban 1997 1998 1998
  • 65. Chemistry Chimeric Hybrid Murine–human MAb Fab Fragment (50,000 Daltons) Cyclic heptapeptide (800 Daltons) Synthetic nonpeptide tyrosine analogue (500 Daltons) Dosing 250 mcg/kg IV (bolus) 180 mcg/kg IV (bolus) + 190 mcg/kg IV (bolus) (after 10 mins) 25 mcg/kg IV (bolus) Abciximab Eptifibatide Tirofiban
  • 66. Chemistry Chimeric Hybrid Murine–human MAb Fab Fragment (50,000 Daltons) Cyclic heptapeptide (800 Daltons) Synthetic nonpeptide tyrosine analogue (500 Daltons) Dosing 250 mcg/kg IV (bolus) + 125 mcg/kg/min (12 hr infusion) 180 mcg/kg IV (bolus) + 190 mcg/kg IV (bolus) (after 10 mins) + 2 mcg/kg/min (24 hr infusion) 25 mcg/kg IV (bolus) + 0.15 mcg/kg/min (18 hr infusion) Half life Plasma T½ 30 minutes ____________ Plasma T½ 15 mins ____________ Plasma T½ 2 hrs ____________ Abciximab Eptifibatide Tirofiban
  • 67. Dosing 250 mcg/kg IV (bolus) + 125 mcg/kg/min (12 hr infusion) 190 mcg/kg IV (bolus) (after 10 mins) + 2 mcg/kg/min (24 hr infusion) 25 mcg/kg IV (bolus) + 0.15 mcg/kg/min (18 hr infusion) Half life Plasma T½ 30 minutes ____________ Platelet-bound T½ in Days Plasma T½ 15 mins ____________ Platelet-bound T ½ in Seconds Plasma T½ 2 hrs ____________ Platelet-bound T ½ in Seconds Return of platelet function 12 hrs 4 hrs 4 hrs Reversible with platelet Yes No No Abciximab Eptifibatide Tirofiban
  • 68. (12 hr infusion) (24 hr infusion) (18 hr infusion) Half life Plasma T½ 30 minutes ____________ Platelet-bound T½ in Days Plasma T½ 15 mins ____________ Platelet-bound T ½ in Seconds Plasma T½ 2 hrs ____________ Platelet-bound T ½ in Seconds Return of platelet function 12 hrs 4 hrs 4 hrs Reversible with platelet transfusion Yes No No Self reversibility No Yes Yes Excretion Unknown Renal clearance Renal clearance PCI PCI Abciximab Eptifibatide Tirofiban
  • 69. with platelet transfusion Yes No No Self reversibility No Yes Yes Excretion Unknown Renal clearance Renal clearance Indication PCI ACS PCI ACS ACS Contra- indication Hypersensitivity (Murine proteins) Bleeding tendency Neuraxial catheter in situ Uncontrolled Hypertension On dialysis Neuraxial catheter in situ h/o ↓ Platelets Neuraxial catheter in situ Immunogenicity Abciximab Eptifibatide Tirofiban
  • 70. platelet transfusion Yes No No Self reversibility No Yes Yes Excretion Unknown Renal clearance Renal clearance Indication PCI ACS PCI ACS ACS Contra- indication Hypersensitivity (Murine proteins) Bleeding tendency Neuraxial catheter in situ Uncontrolled Hypertension On dialysis Neuraxial catheter in situ h/o ↓ Platelets Neuraxial catheter in situ Adverse Immunogenicity Bleeding Bleeding Bleeding Abciximab Eptifibatide Tirofiban
  • 71. Contra- indication Bleeding tendency Neuraxial catheter in situ Hypertension On dialysis Neuraxial catheter in situ h/o ↓ Platelets Neuraxial catheter in situ Adverse effect Immunogenicity Bleeding ↓ Platelets Bradycardia Bleeding ↓ Platelets Bleeding ↓ Platelets Pleiotropic effects Binds to Vitronectin receptor - - Abciximab Eptifibatide Tirofiban
  • 72. Contra- indication Bleeding tendency Neuraxial catheter in situ Hypertension On dialysis Neuraxial catheter in situ h/o ↓ Platelets Neuraxial catheter in situ Adverse effect Immunogenicity Bleeding ↓ Platelets Bradycardia Bleeding ↓ Platelets Bleeding ↓ Platelets Pleiotropic effects Binds to Vitronectin receptor - - Abciximab Eptifibatide Tirofiban Discontinue + Platelet Transfusion Tanzilli G, Sordi M, Arrivi A, Mangieri E, Scappaticci M. Acute profound abciximab induced thrombocytopenia: a correct management of a methodological error. Case Reports. 2009 Oct 5;2009(oct05 1):bcr1220081381–bcr1220081381. Discontinue + Supportive care Discontinue + Supportive care
  • 73. Contra- indication Bleeding tendency Neuraxial catheter in situ Hypertension On dialysis Neuraxial catheter in situ h/o ↓ Platelets Neuraxial catheter in situ Adverse effect Immunogenicity Bleeding ↓ Platelets Bradycardia Bleeding ↓ Platelets Bleeding ↓ Platelets Pleiotropic effects Binds to Vitronectin receptor - - Abciximab Eptifibatide Tirofiban Discontinue + Platelet Transfusion Tanzilli G, Sordi M, Arrivi A, Mangieri E, Scappaticci M. Acute profound abciximab induced thrombocytopenia: a correct management of a methodological error. Case Reports. 2009 Oct 5;2009(oct05 1):bcr1220081381–bcr1220081381. Discontinue + Supportive care Discontinue + Supportive care
  • 74. Contra- indication Bleeding tendency Neuraxial catheter in situ Hypertension On dialysis Neuraxial catheter in situ h/o ↓ Platelets Neuraxial catheter in situ Adverse effect Immunogenicity Bleeding ↓ Platelets Bradycardia Bleeding ↓ Platelets Bleeding ↓ Platelets Pleiotropic effects Binds to Vitronectin receptor - - Abciximab Eptifibatide Tirofiban Discontinue + Platelet Transfusion Tanzilli G, Sordi M, Arrivi A, Mangieri E, Scappaticci M. Acute profound abciximab induced thrombocytopenia: a correct management of a methodological error. Case Reports. 2009 Oct 5;2009(oct05 1):bcr1220081381–bcr1220081381. Discontinue + Supportive care Discontinue + Supportive care
  • 75. Neuraxial catheter in situ Neuraxial catheter in situ Neuraxial catheter in situ Adverse effect Immunogenicity Bleeding ↓ Platelets Bradycardia Bleeding ↓ Platelets Bleeding ↓ Platelets Pleiotropic effects Binds to Vitronectin receptor - - Abciximab Eptifibatide Tirofiban Golan, D. E. (2005). Principles of pharmacology: The pathophysiologic basis of drug therapy. Baltimore: Lippincott Williams & Wilkins.
  • 76. effect ↓ Platelets Bradycardia ↓ Platelets ↓ Platelets Pleiotropic effects Binds to Vitronectin receptor - - Abciximab Eptifibatide Tirofiban
  • 77. effect ↓ Platelets Bradycardia ↓ Platelets ↓ Platelets Pleiotropic effects Binds to Vitronectin receptor - - Abciximab Eptifibatide Tirofiban Current Guidelines Sr. No. Drug Indication Recommendation Class 1 Use of Abciximab Primary PCI Class IIa – Level A 2 Use of Abciximab intracoronary inj. Primary PCI Class IIb – Level B
  • 78. Current Guidelines Sr. No. Drug Indication Recommendation Class 1 Use of Abciximab Primary PCI Class IIa – Level A 2 Use of Abciximab intracoronary inj. Primary PCI Class IIb – Level B 3 Use of Eptifibatide / Tirofiban Primary PCI Class IIa – Level B 4 Discontinuation of GP IIb/IIIa inhibitor Before Urgent CABG Class I – Level B O’Gara P, Kushner F, Ascheim D, Casey D, Chung M, de Lemos J et al. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction. Circulation. 2013;127(4).
  • 79. Sr. No. Drug Indication Recommendation Class 1 Use of Abciximab Primary PCI Class IIa – Level A 2 Use of Abciximab intracoronary inj. Primary PCI Class IIb – Level B 3 Use of Eptifibatide / Tirofiban Primary PCI Class IIa – Level B 4 Discontinuation of GP IIb/IIIa inhibitor Before Urgent CABG Class I – Level B Current Guidelines
  • 80.
  • 89. “Abciximab” 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 1994 EPIC 1. Abciximab 2. Placebo 1997 EPILOG 1. Abciximab + Low dose heparin 2. Abciximab + Standard dose heparin 3. Placebo + Standard dose heparin 1997 CAPTURE 1. Abciximab 2. Placebo 1998 EPISTENT 1. Stenting + Placebo 2. Stenting + Abciximab 3. Balloon angioplasty + Abciximab 2001 GUSTO IV-ACS 1. Placebo + Aspirin + Heparin 2. Abciximab (24 h) + Aspirin + Heparin 3. Abciximab (48 h) + Aspirin + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2004 ISAR REACT 1 1. Abciximab 2. Placebo 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab
  • 90. “Abciximab” 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 1994 EPIC 1. Abciximab 2. Placebo 1997 EPILOG 1. Abciximab + Low dose heparin 2. Abciximab + Standard dose heparin 3. Placebo + Standard dose heparin 1997 CAPTURE 1. Abciximab 2. Placebo 1998 EPISTENT 1. Stenting + Placebo 2. Stenting + Abciximab 3. Balloon angioplasty + Abciximab 2001 GUSTO IV-ACS 1. Placebo + Aspirin + Heparin 2. Abciximab (24 h) + Aspirin + Heparin 3. Abciximab (48 h) + Aspirin + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2004 ISAR REACT 1 1. Abciximab 2. Placebo 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab
  • 91. “Abciximab” 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 1994 EPIC 1. Abciximab 2. Placebo 1997 EPILOG 1. Abciximab + Low dose heparin 2. Abciximab + Standard dose heparin 3. Placebo + Standard dose heparin 1997 CAPTURE 1. Abciximab 2. Placebo 1998 EPISTENT 1. Stenting + Placebo 2. Stenting + Abciximab 3. Balloon angioplasty + Abciximab 2001 GUSTO IV-ACS 1. Placebo + Aspirin + Heparin 2. Abciximab (24 h) + Aspirin + Heparin 3. Abciximab (48 h) + Aspirin + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2004 ISAR REACT 1 1. Abciximab 2. Placebo 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab
  • 92. “Abciximab” 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 1994 EPIC 1. Abciximab 2. Placebo 1997 EPILOG 1. Abciximab + Low dose heparin 2. Abciximab + Standard dose heparin 3. Placebo + Standard dose heparin 1997 CAPTURE 1. Abciximab 2. Placebo 1998 EPISTENT 1. Stenting + Placebo 2. Stenting + Abciximab 3. Balloon angioplasty + Abciximab 2001 GUSTO IV-ACS 1. Placebo + Aspirin + Heparin 2. Abciximab (24 h) + Aspirin + Heparin 3. Abciximab (48 h) + Aspirin + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2004 ISAR REACT 1 1. Abciximab 2. Placebo 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab
  • 93. “Abciximab” 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 1994 EPIC 1. Abciximab 2. Placebo 1997 EPILOG 1. Abciximab + Low dose heparin 2. Abciximab + Standard dose heparin 3. Placebo + Standard dose heparin 1997 CAPTURE 1. Abciximab 2. Placebo 1998 EPISTENT 1. Stenting + Placebo 2. Stenting + Abciximab 3. Balloon angioplasty + Abciximab 2001 GUSTO IV-ACS 1. Placebo + Aspirin + Heparin 2. Abciximab (24 h) + Aspirin + Heparin 3. Abciximab (48 h) + Aspirin + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2004 ISAR REACT 1 1. Abciximab 2. Placebo 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab
  • 94. “Abciximab” 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 1994 EPIC 1. Abciximab 2. Placebo 1997 EPILOG 1. Abciximab + Low dose heparin 2. Abciximab + Standard dose heparin 3. Placebo + Standard dose heparin 1997 CAPTURE 1. Abciximab 2. Placebo 1998 EPISTENT 1. Stenting + Placebo 2. Stenting + Abciximab 3. Balloon angioplasty + Abciximab 2001 GUSTO IV-ACS 1. Placebo + Aspirin + Heparin 2. Abciximab (24 h) + Aspirin + Heparin 3. Abciximab (48 h) + Aspirin + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2004 ISAR REACT 1 1. Abciximab 2. Placebo 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab
  • 95. “Abciximab” 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 1994 EPIC 1. Abciximab 2. Placebo 1997 EPILOG 1. Abciximab + Low dose heparin 2. Abciximab + Standard dose heparin 3. Placebo + Standard dose heparin 1997 CAPTURE 1. Abciximab 2. Placebo 1998 EPISTENT 1. Stenting + Placebo 2. Stenting + Abciximab 3. Balloon angioplasty + Abciximab 2001 GUSTO IV-ACS 1. Placebo + Aspirin + Heparin 2. Abciximab (24 h) + Aspirin + Heparin 3. Abciximab (48 h) + Aspirin + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2004 ISAR REACT 1 1. Abciximab 2. Placebo 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab
  • 96. “Abciximab” 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 1994 EPIC 1. Abciximab 2. Placebo 1997 EPILOG 1. Abciximab + Low dose heparin 2. Abciximab + Standard dose heparin 3. Placebo + Standard dose heparin 1997 CAPTURE 1. Abciximab 2. Placebo 1998 EPISTENT 1. Stenting + Placebo 2. Stenting + Abciximab 3. Balloon angioplasty + Abciximab 2001 GUSTO IV-ACS 1. Placebo + Aspirin + Heparin 2. Abciximab (24 h) + Aspirin + Heparin 3. Abciximab (48 h) + Aspirin + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2004 ISAR REACT 1 1. Abciximab 2. Placebo 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab
  • 97. “Eptifibatide” 1997 IMPACT-II 1. Eptifibatide 2. Placebo 1998 PURSUIT 1. Eptifibatide 2. Placebo 2000 ESPRIT 1. Eptifibatide 2. Placebo 2009 EARLY-ACS 1. Eptifibatide before angiography 2. Eptifibatide after angiography 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
  • 98. “Eptifibatide” 1997 IMPACT-II 1. Eptifibatide 2. Placebo 1998 PURSUIT 1. Eptifibatide 2. Placebo 2000 ESPRIT 1. Eptifibatide 2. Placebo 2009 EARLY-ACS 1. Eptifibatide before angiography 2. Eptifibatide after angiography 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
  • 99. “Eptifibatide” 1997 IMPACT-II 1. Eptifibatide 2. Placebo 1998 PURSUIT 1. Eptifibatide 2. Placebo 2000 ESPRIT 1. Eptifibatide 2. Placebo 2009 EARLY-ACS 1. Eptifibatide before angiography 2. Eptifibatide after angiography 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
  • 100. “Eptifibatide” 1997 IMPACT-II 1. Eptifibatide 2. Placebo 1998 PURSUIT 1. Eptifibatide 2. Placebo 2000 ESPRIT 1. Eptifibatide 2. Placebo 2009 EARLY-ACS 1. Eptifibatide before angiography 2. Eptifibatide after angiography 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
  • 101. “Eptifibatide” 1997 IMPACT-II 1. Eptifibatide 2. Placebo 1998 PURSUIT 1. Eptifibatide 2. Placebo 2000 ESPRIT 1. Eptifibatide 2. Placebo 2009 EARLY-ACS 1. Eptifibatide before angiography 2. Eptifibatide after angiography 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
  • 102. “Eptifibatide” 1997 IMPACT-II 1. Eptifibatide 2. Placebo 1998 PURSUIT 1. Eptifibatide 2. Placebo 2000 ESPRIT 1. Eptifibatide 2. Placebo 2009 EARLY-ACS 1. Eptifibatide before angiography 2. Eptifibatide after angiography 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
  • 103. “Eptifibatide” 1997 IMPACT-II 1. Eptifibatide 2. Placebo 1998 PURSUIT 1. Eptifibatide 2. Placebo 2000 ESPRIT 1. Eptifibatide 2. Placebo 2009 EARLY-ACS 1. Eptifibatide before angiography 2. Eptifibatide after angiography 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
  • 104. “Tirofiban” 1997 RESTORE 1. Tirofiban 2. Placebo 1998 PRISM 1. Tirofiban + Aspirin 2. Aspirin 1998 PRISM-PLUS 1. Tirofiban 2. Heparin 3. Tirofiban + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
  • 105. “Tirofiban” 1997 RESTORE 1. Tirofiban 2. Placebo 1998 PRISM 1. Tirofiban + Aspirin 2. Aspirin 1998 PRISM-PLUS 1. Tirofiban 2. Heparin 3. Tirofiban + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
  • 106. “Tirofiban” 1997 RESTORE 1. Tirofiban 2. Placebo 1998 PRISM 1. Tirofiban + Aspirin 2. Aspirin 1998 PRISM-PLUS 1. Tirofiban 2. Heparin 3. Tirofiban + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
  • 107. “Tirofiban” 1997 RESTORE 1. Tirofiban 2. Placebo 1998 PRISM 1. Tirofiban + Aspirin 2. Aspirin 1998 PRISM-PLUS 1. Tirofiban 2. Heparin 3. Tirofiban + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
  • 108. “Tirofiban” 1997 RESTORE 1. Tirofiban 2. Placebo 1998 PRISM 1. Tirofiban + Aspirin 2. Aspirin 1998 PRISM-PLUS 1. Tirofiban 2. Heparin 3. Tirofiban + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
  • 109. “Tirofiban” 1997 RESTORE 1. Tirofiban 2. Placebo 1998 PRISM 1. Tirofiban + Aspirin 2. Aspirin 1998 PRISM-PLUS 1. Tirofiban 2. Heparin 3. Tirofiban + Heparin 2001 TARGET 1. Tirofiban 2. Abciximab 2011 TENACITY 1. Tirofiban (high dose) 2. Abciximab 2012 SAVI-PCI 1. Eptifibatide 2. Long Tirofiban (high dose) 3. Short Tirofiban (high dose) 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
  • 110. Current fate Mostly replaced in practice due to other classes of drugs especially ADP receptor pathway inhibitors (Prasugrel, Ticagrelor)

Editor's Notes

  1. Typical lead – Lead II