Anti-integrin therapy

The glycoprotein IIb/IIIa integrin receptor binds fibrinogen and is therefore a final common pathway responsible for platelet aggregation. One antibody (abciximab) and two synthetic compounds (tirofiban and eptifibatide) are clinically available to antagonize the function of this receptor. Several large-scale studies have documented the benefit of these compounds in acute coronary syndromes and during percutaneous interventions. Current data suggest that abciximab is the preferred drug in the catheterization laboratory, whereas the other compounds reduce risk for patients with unstable angina before coronary interventions are performed. The highest benefit is achieved in diabetic patients and in patients with elevated troponins. Adverse reactions are rare, and bleeding complications are minor when weight-adjusted heparin is given. Oral compounds have been associated with excess mortality, precluding their clinical use.