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Early trials of platelet glycoprotein IIb/IIIa receptor inhibitors in coronary heart disease

Richard C Becker, MD
Section Editor
Christopher P Cannon, MD
Deputy Editor
Gordon M Saperia, MD, FACC


Platelets play a pivotal role in normal hemostasis, maintaining vascular integrity and preventing continued blood loss after vascular injury. However, they also contribute directly to pathologic vascular thrombosis. This relationship constitutes the rationale for the use of antiplatelet agents in the treatment of coronary heart disease (CHD). (See "The role of platelets in coronary heart disease".)

Three intravenous platelet glycoprotein (GP) IIb/IIIa inhibitors have been studied extensively and are available for clinical use: abciximab, tirofiban, and eptifibatide. Abciximab is a monoclonal antibody directed against the receptor, while tirofiban and eptifibatide are high affinity non-antibody receptor inhibitors.

Antiplatelet therapy with intravenous GP IIb/IIIa inhibitors has been evaluated in patients with acute coronary syndrome (ACS) and in those undergoing intracoronary stent implantation. Dual oral antiplatelet therapy with aspirin and a platelet P2Y12 receptor blocker has decreased the role of GP IIb/IIIa therapy in these settings, although it continues to be important in some subgroups of patients with CHD.

This topic summarizes the early trials of GP IIb/IIIa inhibitors performed before the routine use of intracoronary stents in patients undergoing percutaneous coronary intervention and P2Y12 receptor blocker therapy in patients with ACS or those undergoing stenting. These early trials collectively formed the basis of a high-intensity, platelet-directed approach (in addition to aspirin) to pharmacotherapy for patients at high risk for myocardial infarction (MI), recurring MI, intra-coronary thromboembolism, and, with the increasing deployment of stents in routine clinical practice, acute stent thrombosis.

The role of platelet GP IIb/IIIa inhibitors in patients who receive currently recommended treatment with dual (oral) antiplatelet therapy is discussed elsewhere. (See "Antiplatelet agents in acute non-ST elevation acute coronary syndromes" and "Long-term antiplatelet therapy after coronary artery stenting in stable patients" and "Antiplatelet agents in acute ST elevation myocardial infarction".)


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Literature review current through: Sep 2016. | This topic last updated: Nov 12, 2015.
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