Platelet glycoprotein IIb/IIIa receptor blockade in coronary artery disease

New strategies for profound inhibition of platelet activity at the injured coronary plaque focus on blockade of the platelet surface membrane glycopro tein IIb/IIIa receptor, which binds circulating fibrinogen or von Willebran d factor and crosslinks platelets as the final common pathway to platelet a ggregation. Intravenous agents directed against this receptor include the c himeric monoclonal antibody fragment abciximab, the peptide inhibitor eptif ibatide and nonpeptide mimetics tirofiban and lamifiban. Over 33,000 patien ts have been evaluated in 11 large-scale, placebo-controlled trials of thes e agents. During percutaneous coronary intervention, an absolute reduction of 1.5% to 6.5% in the 30-day risk of death, myocardial infarction or repeat urgent r evascularization has been observed, with some variability in treatment effe ct among the agents tested (abciximab, eptifibatide and tirofiban). Treatme nt effect is achieved early with every modality of revascularization and is maintained over the long-term (up to three years). Increased bleeding risk may be minimized by reduction and weight-adjustment of concomitant heparin dosing. In the acute coronary syndromes without ST segment elevation, abso lute 1.5% to 3.2% reductions in 30-day rates of death or myocardial (re-) i nfarction have been achieved with two to four day courses of eptifibatide o r tirofiban. Clinical benefit accrues during the period of drug infusion an d is durable. Treatment effect may be enhanced among patients undergoing ea rly coronary revascularization, with evidence of stabilization before inter vention and suppression of postprocedural ischemic events. Thus, blockade o f the platelet glycoprotein IIb/IIIa receptor reduces ischemic complication s when used as an adjunct to percutaneous coronary intervention or the mana gement of acute ischemic syndromes. (J Am Cell Cardiol 2000;35:1103-15) (C) 2000 by the American College of Cardiology.