What is the current role of
glycoprotein IIb/IIIa receptor
antagonists?
Use of glycoprotein IIb/IIIa receptor antagonists
has declined sharply in the last 5 years with the
increasing use of pretreatment with ADP antagonists,
the use of bivalirudin (a direct thrombin
inhibitor) at the time of PCI and the emerging
role of newer molecules.
16,17,29 This class of drug,
which includes abciximab, eptifibatide and
tirofiban, inhibits platelet aggregation by preventing
binding of fibrinogen between platelets
via the glycoprotein IIb/IIIa receptors. These
agents are still indicated for patients who did not
receive dual antiplatelet therapy, for patients who
have recurrent symptoms despite dual antiplatelet
therapy, or at the time of PCI for patients
with ST elevation MI who are receiving intravenous
unfractionated heparin. Pretreatment
with these drugs before primary PCI in ST elevation
MI was not associated with benefit in terms
of major cardiovascular events and increased
bleeding complications.
30–32 In contemporary
practice, they are mostly given at the time of PCI
in the event of procedural complications