title: The use of adjunctive GPIIb/IIIa inhibitors in patients with unstable angina/non-Q-wave MI undergoing percutaneous coronary intervention.
abstract: Glycoprotein IIb/IIIa receptor inhibitors represent a relatively new therapeutic approach in the field of antiplatelet therapy. Following the development of abciximab a number of small molecule GPIIb/IIIa inhibitors have been introduced such as tirofiban and eptifibatide. In this fast-moving field the interventional cardiologist needs a framework to guide decision-making for the individual patient. This review covers the efficacy and safety data from the clinical trials of GPIIb/IIIa inhibitors in the context of patients undergoing percutaneous coronary intervention for unstable angina/non-Q-wave myocardial infarction. There is an increasing body of evidence to support the efficacy of GPIIb/IIIa inhibitors in reducing the risk of adverse ischemic events in high and low risk patients undergoing percutaneous coronary intervention. A number of unresolved efficacy and safety issues remain, including the duration of treatment before and after intervention; whether a reduction in the heparin dose would further decrease the risk of hemorrhage without affecting the periprocedural thrombotic rate in patients undergoing PTCA with adjunctive GPIIb/IIIa inhibitors; and the cost-effectiveness of this therapy. When a thorough analysis of cost-effectiveness has been made, it will be easier to advocate the widespread use of these agents in all patients undergoing coronary intervention.
authors.affiliation: The Andreas Gruentzig Cardiovascular Center, Department of Interventional Cardiology Emory University Hospital, Atlanta, USA, 2St Mary's Hospital, Portsmouth, UK.
authors.forename: Mahomed Y
authors.initials: MY
authors.lastname: Salame
authors.forename: Ranjit S
authors.initials: RS
authors.lastname: More
authors.forename: Stefan
authors.initials: S
authors.lastname: Verheye
authors.forename: Mark E
authors.initials: ME
authors.lastname: Leimbach
authors.forename: Spencer B
authors.initials: SB
authors.lastname: King
authors.forename: Nicolas AF
authors.initials: NA
authors.lastname: Chronos