Perspectives on the future of platelet glycoprotein IIb/IIIa blockade therapy

During the past 2 decades, advances in molecular and cellular biology have greatly expanded our understanding of the critical role of platelets in the pathogenesis of acute coronary syndromes. This work has suggested that aggressive platelet inhibition might reduce cardiovascular morbidity and mortality rates beyond the reductions already achieved with aspirin and other conventional therapies. Researchers in basic science laboratories have identified a specific platelet receptor, the glycoprotein IIb/IIIa integrin, which serves as the mediator, or final common pathway, leading to platelet aggregation. This glycoprotein receptor is a logical target for the development of antagonists to inhibit thrombosis. A number of these antagonists have been tested in clinical trials involving coronary intervention, unstable angina, and acute myocardial infarction. Herein, I present some of the rationale behind the investigation of these agents, as well as some issues to be considered with regard to the future of this exciting new class of drugs.