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 common pathophysiological mechanism of intimal disruption and platelet aggregation. Glycoprotein (GP) IIb/IIIa receptor antagonists, which interrupt the final common pathway of platelet activation and aggregation, have been shown to have clear clinical benefit as acute therapy. Treatment of 1000 patients with parenteral formulations prevents at least 1 death, 20 deaths or myocardial infarctions (MIs), and 30 deaths, MIs or revascularisation procedures over a 30-day period. These benefits are sustained at 6 months. Clinical trials of oral formulations are underway. The challenges of dose, haemorrhage and thrombocytopenia must be surmounted before oral antagonists can be incorporated into clinical practice. Despite enrolment of thousands of patients in randomised trials of GPIIb/IIIa antagonists, much additional information is needed to refine the use of this therapy in practice. Application of this drug class will advance a new therapeutic standard for ischaemic heart disease.