Bleeding complications of glycoprotein IIb-IIIa receptor inhibitors

Large clinical studies have demonstrated an unequivocal clinical benefit of antithrombotic therapy with inhibitors of the platelet surface-membrane gl ycoprotein (GP) IIb-IIIa receptor in a broad range of patients with ischemi c heart disease. Potent antiplatelet effects of these agents, however, may increase the risk of bleeding complications, as occurred in the first large evaluation of this therapy, the Evaluation of c7E3 for Prevention of Ische mic Complications (EPIC) trial with abciximab (c7E3 Fab; ReoPro(R); Centoco r, Malvern, Pa). Although the incidence of bleeding events in subsequent st udies has been reduced through the use of a low-dose, weight-adjusted hepar in regimen and early removal of vascular sheaths in patients who have under gone percutaneous coronary interventions, hemorrhage continues to be the mo st common complication of GP IIb-IIIa inhibitor therapy. This review summar izes current experience related to bleeding complications with various GP I Ib-IIIa inhibitors and suggests strategies for improved management of bleed ing in patients receiving these agents.