Differences among GP IIb/IIIa inhibitors: different clinical benefits in non-ST-segment elevation acute coronary syndrome percutaneous coronary intervention patients

Abciximab, eptifibatide, and tirofiban are the glycoprotein (GP) IIb/IIIa inhibitors most extensively studied in several randomized trials involving thousands of patients with acute coronary syndromes (ACS) or undergoing percutaneous coronary intervention (PCI). Despite the differences in structure and pharmacology of abciximab as compared to eptifibatide and tirofiban, it is unknown if different IIb/IIIa antagonists may provide different outcomes in relation to their structural differences in patients with ACS. Abciximab has been associated with a long-term decrease in mortality, an effect that cannot be entirely attributed to the suppression of acute periprocedural ischaemic events, whereas mortality reduction has not been observed to date with eptifibatide or tirofiban. Different from eptifibatide and tirofiban, abciximab blinds to GP IIb/IIIa receptor as well as to alpha(v)beta(3) integrin receptor of endothelial and smooth muscle cells, and to alpha(m)beta(2) integrin found in leucocytes. As a consequence, abciximab has the potential for direct inhibition of adhesion of platelets and endothelial cells and of platelets and white cells, and subsequent inhibition of the inflammatory process invariably present in ACS and after PCI.