Prospective use of glycoprotein IIb/IIIa receptor blockers in the emergency department setting

Platelets play a pivotal role in the pathophysiology of acute coronary synd romes (ACS) and thus are logical therapeutic targets for treatment of this disease process. Platelet glycoprotein (GP) IIb/IIIa receptor antagonists, which interrupt the final common pathway of platelet aggregation, have been proved to reduce the 30-day incidence of death, acute myocardial infarctio n (MI), and urgent revascularization in both high-risk and low-risk patient s undergoing percutaneous intervention procedures. Three-year follow-up has indicated that these benefits appear durable. Recent large-scale randomize d trials have demonstrated the Value of GP IIb/IIIa receptor inhibitors in reducing the risk of death and MI in patients with unstable angina or those with MI with non-Q-wave abnormalities who are receiving pharmacologic mana gement. In addition, emerging evidence suggests a future role for GP IIb/II Ia receptor inhibitors as an adjunct to low-dose fibrinolytic therapy in pa tients with acute Ml. As the list of indications far GP IIb/IIIa receptor a ntagonists expands to encompass the full spectrum of ACS, there is increasi ng interest in the potential use of these agents in the emergency departmen t setting. The integration of GP IIb/IIIa receptor inhibitors into ED proto cols will ultimately depend largely on whether these drugs prove to be safe and effective regardless of the direction of ST-segment deviation, and irr espective of whether definitive therapy will be invasive or conservative.