Glycoprotein IIb-IIIa inhibitors for acute ischaemic stroke

Abstract

Background: Glycoprotein (GP) IIb-IIIa inhibitors block the final common pathway to platelet aggregation antagonising with receptors that bind fibrinogen molecules forming bridges between adjacent platelets. Thus, GP IIb-IIIa inhibitors could favour endogenous thrombolysis by reducing thrombus growth and prevent thrombus re-formation by competitive inhibition with fibrinogen. Currently used in clinical practice for acute coronary syndromes and percutaneous coronary interventions, they could also be useful for patients with acute ischaemic stroke. Objectives: To assess efficacy and safety of GP IIb-IIIa inhibitors in acute ischaemic stroke. Search strategy: We searched the Cochrane Stroke Group trials register (last searched 31 May 2005). In addition, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2005), MEDLINE (1966 to June 2005) and EMBASE (1980 to June 2005). In an effort to identify further published, unpublished and ongoing trials we searched reference lists and contacted trial authors and pharmaceutical companies. Selection criteria: We aimed to analyse unconfounded randomised controlled trials comparing GP IIb-IIIa inhibitors with placebo in patients with acute ischaemic stroke. Only patients who started the treatment within six hours of stroke onset were included. Data collection and analysis: Three review authors independently selected trials for inclusion, assessed trial quality and extracted the data. Main results: Two trials involving 474 patients were included. Only data for 414 patients treated within six hours were considered. Patients were treated with intravenous abciximab or placebo. Treatment with abciximab was associated with a non-significant reduction of death and dependency combined (odds ratio (OR) 0.79; 95% confidence interval (CI) 0.54 to 1.17) and of death alone (OR 0.67; 95% CI 0.36 to 1.25). Treatment with abciximab was associated with a non-significant increase of symptomatic intracranial haemorrhages (OR 4.13; 95% CI 0.86 to 19.67) and of major extracranial haemorrhages (OR 1.51; 95% CI 0.25 to 9.12). Authors' conclusions: There is currently not enough evidence from randomised controlled trials regarding the efficacy or safety of GP IIb-IIIa inhibitors therapy in acute ischaemic stroke. Results from ongoing trials will help to understand the risk to benefit ratio of these agents. Copyright © 2006 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.