Glycoprotein IIB/IIIA Inhibitor

Aka: Glycoprotein IIB/IIIA Inhibitor, Glycoprotein IIb/IIIa Antagonist, GP IIB/IIA Inhibitor, GP2B3A Inhibitor

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II. Indications

  1. Non-Q-Wave Myocardial Infarction
  2. High risk Unstable Angina
  3. Angioplasty

III. Contraindications

  1. Recent major bleeding

IV. Mechanism

  1. Inhibits Platelet aggregation via Glycoprotein IIb/IIIa receptors on Platelet plasma membranes
  2. Inhibits Fibrinogen binding to Platelets

V. Medications

  1. Abciximab (ReoPro)
    1. Percutaneous Coronary Intervention (PCI)
      1. Load: 0.25 mg/kg IV bolus given 10 to 60 minutes before PCI
      2. Infuse: 0.125 mcg/kg/min up to 10 mcg/min IV for 12 hours
    2. Unstable Angina or non-ST-elevation Myocardial Infarction pending PCI within 24 hours
      1. Dosing as for PCI, with infusion up to 18 to 24 hours, completing at one hour post-PCI
    3. Coronary Aneursym in Kawasaki Disease
      1. Off label use for age >2 months old
      2. Dosing as used in PCI
  2. Eptifibatide (Integrilin)
    1. Acute Coronary Syndrome
      1. Load: 180 mcg/kg IV bolus
      2. Infuse: 2 mcg/kg/min IV for up to 72 hours
    2. Percutaneous Coronary Intervention (PCI)
      1. Bolus 180 mcg/kg IV immediately before procedure and again 10 minutes after the first dose
      2. Infuse: 2 mcg/kg/min IV for 18 to 24 hours after procedure (at least 12 hours)
    3. Renal Impairment (GFR<50 ml/min)
      1. Decrease infusion rate to 1 mcg/kg/min
    4. Obesity (weight >121 kg)
      1. Maximum bolus dose: 22.6 mg
      2. Maximum infusion rate 15 mg/hour (7.5 mg/hour if GFR<50 ml/min)
  3. Tirofiban (Aggrastat)
    1. Non-ST elevation Myocardial Infarction (NSTEMI)
      1. Load: 25 mcg/kg over 5 min
      2. Infuse: 0.15 mcg/kg/min for up to 18 hours
        1. Slow rate to 0.075 mcg/kg/min if GFR <=60 ml/min

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