title: Is There Still a Role for Glycoprotein IIb/IIIa Antagonists in Acute Coronary Syndromes?
abstract: The role played by glycoprotein (GP) IIb/IIIa inhibitors has continuously evolved from the initial introduction in mid 90 s until the most recent guidelines for treating acute coronary syndromes, and competed with a wider use of ADP inhibitors and novel anticoagulant drugs, to the extent that they stepped down from class I to class II recommendation in the routine setting of acute coronary syndromes. As a consequence, GP IIb/IIIa use was greatly narrowed. The purpose of this review is to define the roles that GP IIb/IIIa inhibitors may still have in acute ischemic settings by explaining why in high risk patients they might be preferable and/or whether they might be added to ADP inhibitors also emphasizing the underlying mechanistic actions. It is concluded that there might be a more extensive use of GP IIb/IIIa inhibitors in patients presenting with acute coronary syndromes, strictly based on the definition for a high risk procedure: complexity, angiographic characteristics and patient's risk profile, regardless whether STEMI or NSTEMI. The positive elements one should appreciate in GP IIb/IIIa inhibitors are: efficacy, rapid onset and reversibility of action, absence of pharmacogenomic variability, pharmacoeconomic considerations and the possibility of intracoronary administration.
authors.affiliation: Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza, University of Rome, Italy.
authors.forename: Loredana
authors.initials: L
authors.lastname: Iannetta
authors.affiliation: Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza, University of Rome, Italy.
authors.forename: Paolo Emilio
authors.initials: PE
authors.lastname: Puddu
authors.affiliation: Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza, University of Rome, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Cuturello
authors.affiliation: Sant'Anna Hospital, Catanzaro, Italy.
authors.forename: Angela
authors.initials: A
authors.lastname: Saladini
authors.affiliation: Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza, University of Rome, Italy.
authors.forename: Mariano
authors.initials: M
authors.lastname: Pellicano
authors.affiliation: Department of Cardiovascular, Respiratory, Nephrological, Anesthesiological and Geriatric Sciences, Sapienza, University of Rome, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Schiariti
keywords: Acute coronary syndromes; Acute ischemia; GP IIb/IIIs inhibitors; High risk patients; PCI