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 glycoprotein (GP) IIb-IIIa receptor in a broad range of patients with ischemic 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 Ischemic Complications (EPIC) trial with abciximab (c7E3 Fab; ReoPro((R)); Centocor, Malvern, Pa). Although the incidence of bleeding events in subsequent studies has been reduced through the use of a low-dose, weight-adjusted heparin regimen and early removal of vascular sheaths in patients who have undergone percutaneous coronary interventions, hemorrhage continues to be the most common complication of GP IIb-IIIa inhibitor therapy. This review summarizes current experience related to bleeding complications with various GP IIb-IIIa inhibitors and suggests strategies for improved management of bleeding in patients receiving these agents.