Current role of platelet glycoprotein IIb/IIIa inhibitors in acute coronary syndromes.
BACKGROUND
The central role of platelet-rich thrombus in the pathogenesis of acute coronary syndromes (ACSs) is well-known. Glycoprotein IIb/IIIa (Gp IIb/IIIa) receptor antagonists are potent inhibitors of platelet function that may be expected to affect favorably the natural history of ACSs.


OBJECTIVE
To define the optimal role of Gp IIb/IIIa inhibitors in treatment strategies for ACSs.


METHODS
A MEDLINE search was performed to identify all English-language articles regarding use of Gp IIb/IIIa inhibitors in ACSs published between 1966 and June 2000. In addition, relevant abstracts from the annual meetings of the American Heart Association, American College of Cardiology, and the European Society of Cardiology were reviewed.


METHODS
Only studies of 500 or more patients were included. Of 15 studies identified, 10 randomized, placebo-controlled, double-blind trials of Gp IIb/IIIa inhibitors in ACSs were selected for review.


METHODS
Data quality was determined by publication in the peer-reviewed literature or presentation at an official cardiology society-sponsored meeting, as well as by verification with the primary author.


RESULTS
Three members of this class of drugs are available for intravenous use. Abciximab, eptifibatide, and tirofiban hydrochloride, each have data demonstrating their value in improving the outcomes of patients presenting with ACSs. Current evidence supports use of these drugs in both conservative and invasive treatment strategies. Glycoprotein IIb/IIIa-blocking therapy is safe, and with proper precautions, bleeding risks can be minimized. Biological differences exist among these agents, but as of yet, no head-to-head comparisons have been made of their clinical efficacy. Unlike intravenous Gp IIb/IIIa inhibitors, available data regarding any role of oral Gp IIb/IIIa inhibitors are not favorable.


CONCLUSIONS
Current data indicate that intravenous Gp IIb/IIIa inhibitor therapy merits a prominent role in the initial management of patients with ACSs. JAMA. 2000;284:1549-1558.
Bhatt
D L
DL
Department of Cardiology, F25, Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195, USA. topole@ccf.org
Topol
E J
EJ
D000077284:Abciximab; D000208:Acute Disease; D000409:Alanine / Q000627:therapeutic use; D000789:Angina, Unstable / Q000188:drug therapy*; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use; D001550:Benzamidines / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D000077542:Eptifibatide; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D009203:Myocardial Infarction / Q000188:drug therapy*; D010091:Oximes / Q000627:therapeutic use; D010455:Peptides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D010880:Piperidines / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011759:Pyrrolidines / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D015607:Stents; D000077466:Tirofiban; D014443:Tyrosine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use*
D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D001550:Benzamidines; D006495:Heparin, Low-Molecular-Weight; D007140:Immunoglobulin Fab Fragments; D010091:Oximes; D010455:Peptides; D010880:Piperidines; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011759:Pyrrolidines; D014443:Tyrosine; C120234:orbofiban; D000077466:Tirofiban; D000077542:Eptifibatide; D000409:Alanine; C091295:xemilofiban; D000077284:Abciximab; C100917:sibrafiban