A rapid and systematic review of the clinical effectiveness and cost-effectiveness of glycoprotein IIb/IIIa antagonists in the medical management of unstable angina
BackgroundGlycoprotein IIb/IIIa is a receptor on the platelet membrane. This receptor is the final common pathway of platelet aggregation, which is considered to be a major factor in thrombus formation and MI. Therefore, in theory, antagonists of glycoprotein IIb/IIIa could play a very important role in the treatment of unstable angina. Glycoprotein IIb/IIIa antagonists can be used in conjunction with percutaneous coronary intervention (PCI), but this review was limited to their use in patients for whom PCI was not planned. This review considered administration of the drugs both intravenously over a few days during the acute episode and orally over several weeks.
Evidence from randomised trials was found for six glycoprotein IIb/IIIa antagonists: tirofiban, eptifibatide, lamifiban, sibrafiban, orbofiban and lefradafiban. If inadequate reporting does not reflect inadequate study conduct, the trials generally seem to be of good quality. For the composite end-points measured at 30 days, the trials investigating the intravenous use of the drugs tended to show small to very small benefits and slightly higher rates of side-effects associated with the glycoprotein IIb/IIIa antagonists. The main adverse effect monitored was bleeding. The results for the trials investigating the oral administration of these drugs were consistently negative: no benefits and possibly more bleeding. The cost-effectiveness analysis found discrepancies between US and UK based data.Conducted by: MS McDonagh1, LM Bachmann2, S Golder1, J Kleijnen1, G ter Riet1,3
1. NHS Centre for Reviews and Dissemination; 2 Horten Zentrum, Zürich University; 3. Department of Epidemiology, Maastricht University
Further detailsProject page on HTA Programme website
Related guidanceCommissioned to inform NICE Technology Appraisal 12: Glycoprotein IIb/IIIa inhibitors in the treatment of acute coronary syndromes. London: National Institute for Clinical Excellence; 2000
PublicationsMcDonagh MS, Bachmann LM, Golder S, Kleijnen J, ter Riet G. A rapid and systematic review of the clinical effectiveness and cost-effectiveness of glycoprotein IIb/IIIa antagonists in the medical management of unstable angina. Health Technol Assess. 2000;4(30):1-95
Commissioned by the HTA Programme on behalf of NICE's Technology Assessment Report (TAR) process