What is the role of glycoprotein IIb/IIIa receptor antagonists in the treatment of acute coronary syndrome (ACS)?

Updated: Sep 30, 2020
  • Author: David L Coven, MD, PhD; Chief Editor: Eric H Yang, MD  more...
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Answer

Glycoprotein IIb/IIIa receptor antagonists include abciximab, [82, 83] eptifibatide, [84] and tirofiban. [85] These drugs inhibit the glycoprotein IIb/IIIa receptor, which is involved in the final common pathway for platelet adhesion and aggregation. (See the image below.)

Use of cardiac markers in the ED. Effect of time t Use of cardiac markers in the ED. Effect of time to treatment in patients with acute coronary syndrome (ACS) who are treated with the GIIb/IIIa inhibitor eptifibatide.

Use eptifibatide or tirofiban in patients with high-risk features in whom invasive treatment is not planned.

The use of eptifibatide 12 hours or more before angiography was not superior to the provisional use of eptifibatide after angiography, according to results from the EARLY ACS trial. The study compared a strategy of early, routine administration of eptifibatide with delayed, provisional administration in patients who had ACS without ST-segment elevation and who were assigned to an invasive strategy. The study also found that early use of eptifibatide was associated with an increased risk of non–life-threatening bleeding and the need for transfusion. [86]

Two trials with tirofiban and 1 trial with eptifibatide documented their efficacy in unstable angina/NSTEMI patients, only some of whom underwent interventions. These antagonists are a class I recommendation in patients in whom catheterization and PCI are planned. Intermediate- and high-risk patients appear to respond favorably to glycoprotein IIb/IIIa inhibitors. [87] They include patients with ST-segment depression, elevated risk scores, elevated serum troponin levels, [88] and/or diabetes mellitus.

Currently, IIb/IIIb antagonists in combination with aspirin are considered standard antiplatelet therapy for patients at high risk for unstable angina.


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