Summary
Platelet glycoprotein IIb/IIIa inhibitors (GPI) are antithrombotic agents preventing
the binding of fibrinogen to GP IIb/IIIa receptors. Thus, GPI interfere with interplatelet
bridging mediated by fibrinogen. Currently, three generic GPI with different antithrombotic
properties are available for intravenous administration: abciximab, eptifibatide,
and tirofiban. The development of oral GPI was abandoned, whereas intravenous GPI
were introduced in various clinical settings during the 1990s, yielding substantial
benefit in the treatment of acute coronary syndromes, particularly during percutaneous
coronary interventions. Results of the many randomised trials evidenced the efficacy
of this drug class, though these trials were conducted prior to the emergence of modern
oral antiplatelet therapy with efficient P2Y12 inhibitors. Subsequent trials failed to consolidate the strongly favourable impression
of GPI, and indications for their use have been more restricted in recent years. Nonetheless,
GPI may still be beneficial during coronary interventions among high-risk patients
including acute ST-elevation and non-ST-elevation myocardial infarctions, particularly
in the absence of adequate pretreatment with oral antiplatelet drugs or when direct
thrombin inhibitors are not utilised. Intracoronary GPI administration has been suggested
as adjunctive therapy during primary percutaneous coronary intervention, and the results
of larger ongoing trials are expected to elucidate its clinical potential. The present
review outlines the key milestones of GPI development and provides an up-to-date overview
of the clinical applicability of these drugs in the era of refined coronary stenting,
potent antithrombotic drugs, and novel thrombin inhibiting agents.
Keywords
Abciximab - acute coronary syndrome - antiplatelet agents - glycoprotein IIb/IIIa
inhibitors - percutaneous coronary intervention
