Glycoprotein IIb/IIIa receptor antagonists in non-ST elevation acute coronary syndromes and percutaneous revascularisation - A review of trial reports

Acute coronary syndromes and percutaneous coronary interventions share a co mmon pathophysiological mechanism of intimal disruption and platelet aggreg ation. Glycoprotein (GP) IIb/IIIa receptor antagonists, which interrupt the final common pathway of platelet activation and aggregation, have been sho wn to have clear clinical benefit as acute therapy. Treatment of 1000 patie nts with parenteral formulations prevents at least 1 death, 20 deaths or my ocardial infarctions (MIs), and 30 deaths, MIs or revascularisation procedu res over a 30-day period. These benefits are sustained at 6 months. Clinica l trials of oral formulations are underway. The challenges of dose, haemorr hage and thrombocytopenia must be surmounted before oral antagonists can be incorporated into clinical practice. Despite enrolment of thousands of pat ients in randomised trials of GPIIb/IIIa antagonists, much additional infor mation is needed to refine the use of this therapy in practice. Application of this drug class will advance a new therapeutic standard for ischaemic h eart disease.