Glycoprotein IIbIIIa Inhibitors: ACS Non-PCI

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Acute coronary syndrome non-PCI (medical management) is usually the least desirable approach compared with PCI/CABG, but this may be the only reasonable approach for many because of coronary anatomy, the patient's physical condition, desires of the patient and his family, and the availability of medical resources, to name a few. This category of patients is one of the most studied in larger glycoprotein IIbIIIa inhibitor (GP2b3aI) trials. A recent meta-analysis (Lancet 2002;359:180), which included Lamifiban, a GP2b3aI not available in the U.S., and which had some of the more favorable results, revealed no differences in mortality or acute MI compared with placebo. The four studies of ACS non-PCI (medical management) which involved the three GP2b3aIs available in the U.S. were PRISM and PRISM-PLUS (tirofiban), PURSUIT (eptifibatide), and GUSTO IV (abciximab).

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