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GP IIb/IIIa antagonists. Clinical experience and potential uses in cardiology
1Department of Medicine, Bayer College of Medicine, Texas Medical Center, Houston, USA. nkleiman@bcm.tmc.edu
Insights
Platelet glycoprotein IIb/IIIa antagonists reduce ischemic events in acute coronary syndromes and percutaneous coronary interventions. This review covers abciximab, tirofiban, and eptifibatide, detailing their pharmacology and clinical trial outcomes.
Area of Science:
- Cardiology
- Pharmacology
- Hematology
Background:
- Platelet aggregation, mediated by glycoprotein (GP) IIb/IIIa, is central to acute coronary syndromes and periprocedural complications after coronary interventions.
- GP IIb/IIIa antagonists target this pathway by inhibiting fibrinogen binding to activated platelets.
Purpose of the Study:
- To review available antagonists of platelet GP IIb/IIIa.
- To discuss their role in managing ischemic heart disease.
Main Methods:
- Review of pharmacological characteristics of abciximab, tirofiban, and eptifibatide.
- Analysis of clinical trials evaluating these agents in ischemic heart disease.
Main Results:
- Inhibition of GP IIb/IIIa reduces ischemic complications in coronary interventions.
- These agents decrease rates of death and myocardial infarction in acute coronary syndromes.
Conclusions:
- GP IIb/IIIa antagonists are effective in reducing ischemic complications.
- Differential pharmacological profiles exist among abciximab, tirofiban, and eptifibatide.
Abstract:
The purpose of this manuscript is to review the available antagonists of platelet glycoprotein (GP) IIb/IIIa. The critical role of platelet aggregation in the pathogenesis of acute coronary syndromes of unstable angina and non-Q-wave myocardial infarction, as well as in mediating abrupt vessel closure and periprocedural infarction after percutaneous coronary interventions, has been recognised recently. Platelet aggregation is mediated through expression of activated GP IIb/IIIa and its subsequent binding to circulating fibrinogen. Inhibition of this interaction with one of 3 commercially available agents has been demonstrated to reduce ischaemic complications of coronary intervention and to reduce the rates of death and myocardial infarction in patients with acute coronary syndromes. Differential pharmacological characteristics of the drugs abciximab, tirofiban and eptifibatide are described and the trials which have defined their role in the management of ischaemic heart disease are reviewed.