Utilization of GP IIb/IIIa inhibitors in peripheral percutaneous interventions: current applications and in-hospital outcomes at a tertiary referral center.

The pattern of use of glycoprotein (GP) IIb/IIIa receptor inhibitors in peripheral percutaneous interventions (PPI) remains unclear. Data on patients who received GP IIb/IIIa inhibitors during PPI were extracted from a prospective registry that tracks demographic, angiographic and in-hospital outcomes of patients at 2 medical centers. Primary success was defined as establishing thrombolysis in myocardial infarction (TIMI) 3 flow and < 30% residual in vessels treated. Primary safety endpoints included death, unplanned amputation, vascular access complications, major bleeding and thrombocytopenia. Patients were divided into planned versus bailout use of GP IIb/IIIa inhibitors. A total of 46 patients (128 vessels) were included in this study. The procedure was performed emergently, urgently and electively in 13%, 26.1% and 60.9% of patients, respectively. The mean age was 70.9 +/- 11.2 years and 52.2% of patients were males. The patients' Rutherford-Baker Classes III, IV and V-VI were observed in 32.6%, 32.6% and 34.8%, respectively. Patients had the following comorbidities: current smokers 37%, diabetics 35.8%, dyslipidemics 71.7% and hypertensives 78.3%. Angiographic thrombus was suspected in 45.7% of patients prior to and during the procedure. The primary success endpoint was met in 66.4% of vessels and 69.6% of patients. Primary safety endpoints were as follows: death 2.2%, vascular access complication 2.2%, major unplanned amputation 0%, major bleeding 0% and thrombocytopenia 2.2%. Treatment with GP IIb/IIIa inhibitors was planned in 13 (28.3%) patients and bailout in 33 patients (71.7%). Reasons for planned GP IIb/IIIa were the presence of angiographic thrombus in 7 (53.8%) patients, advanced limb ischemia (Rutherford-Baker IV-VI) with total occlusions in 5 (38.5%) patients and acute presentation with total occlusion in 1 (7.7%) patient. Reasons for bailout were slow-flow in 16 (48.5%) patients, thrombus with no slow-flow in 12 (36.4%) patients, poor runoff in 1 (3%) patient and preventative during the procedure in 4 (12%) patients. In patients who received planned GP IIb/IIIa treatment, slow-flow occurred in 1/13 (7.7%) and embolization in 0/13 (0%) patients. We conclude that GP IIb/IIIa inhibitors were used as adjunctive therapy prior to angioplasty in critical limb ischemia patients or thrombotic lesions or as bailout in patients experiencing slow-flow and thrombus during PPI. Planned GP IIb/IIIa inhibitors appear to have favorable outcomes with a low incidence of slow-flow and embolization, however, randomized data are needed before establishing the role of GP IIb/IIIa inhibitor use in high-risk PPI.