Trials of glycoprotein IIb-IIIa inhibitors in non-ST-segment elevation acute coronary syndromes: Applicability to the practice of medicine in the United States

Platelet-mediated thrombosis has been recognized as the primary pathophysio logic mechanism of acute coronary syndromes (ACS) and acute complications o f percutaneous coronary intervention (PCI). Despite the clinical efficacy o f the two most widely used antithrombotic agents, aspirin and heparin, each of them has significant therapeutic limitations. As a result, thrombosis a nd clinical events may occur despite the use of aspirin and heparin. The di scovery that the platelet glycoprotein (GP) IIb-IIIa represents the final c ommon pathway to platelet aggregation and the growing recognition of the ke y role of platelets in the progression of thrombosis prompted the developme nt of several GP IIb-IIIa inhibitors as a potentially more effective form o f antithrombotic therapy. Numerous trials of various GP IIb-IIIa inhibitors as adjuncts to PCI have strongly supported this hypothesis. The subject of this supplement is the review of more recent evaluations of GP IIb-IIIa in hibitors in the context of various treatment strategies for the management of patients with unstable angina or non-ST-segment elevation myocardial inf arction, collectively known as non-ST-segment elevation ACS. Appropriate tr anslation of these trials into clinical practice requires not only the know ledge of the trials' results but also the understanding of the design of in dividual studies, most notably the entry criteria and patient management st rategies.