IIb/IIIa Receptor blockade in acute myocardial infarction

To appreciate the clinical potential of antiplatelet therapy in the treatme nt of patients with acute myocardial infarction (MI): it is important to un derstand the mechanism and pathophysiology of acute MI and to understand th e role that platelets ploy In the process of acute thrombus formation. Reco gnition of the limitations of current therapy has sparked intense interest in the development of more potent platelet inhibitors such as antagonists o f the platelet glycoprotein (GP) IIb/IIIa receptor. Because this receptor r epresents the final common pathway of platelet aggregation, it emerges as a very attractive therapeutic target for phamacologic interventions. The pur pose of this review is to summarize the results of recent large-scale clini cal trials that use GP IIb/IIIa antagonist therapy in patients with acute M I both as an adjunct to percutaneous coronary interventions and as an adjun ct to exogenously administered fibrinolytic therapy. As an adjunct to percu taneous coronary interventions, GP IIb/IIIa antagonists have shown signific ant benefit in the prevention of composite end points of death, MI, and eme rgency revascularization. As an adjunct to fibrinolytic agents, GP IIb/IIIa antagonists enhance the speed and degree of reperfusion achievable pharmac ologically. Although the potential risk of bleeding remains a concern (part icularly with higher doses of streptokinase), recent phase II trials such a s TIMI 14 and SPEED suggest considerable potential for these potent antipla telet agents in the medical treatment of patients with acute MI.