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The Potential Role of Glycoprotein IIb/IIIa Inhibitors in the ED

This well-written literature survey supports the use of glycoprotein IIb/IIIa receptor blockers in the management of acute coronary syndromes. Binding of the IIb/IIIa receptors on platelet surfaces to fibrinogen and other adhesive proteins is the first step in platelet aggregation and subsequent formation of platelet-rich thrombi. Receptor blockers, such as abciximab, eptifibatide, tirofiban, and lamifiban (not yet on the market), inhibit thrombus formation by interfering with platelet-fibrinogen binding.

Studies have shown that this class of drugs has utility in preventing iatrogenic thrombus formation after percutaneous coronary intervention (EPIC and EPILOG studies); as an adjunct to therapy in unstable angina (EPIC); as an adjunct to medical stabilization with heparin, nitrates, and other antianginal agents before intervention (CAPTURE); and as medical therapy in unstable angina and non-Q-wave acute MI (PARAGON, PRISM, PRISM-PLUS, and PURSUIT). Studies of glycoprotein IIb/IIIa receptor blockers in acute MI (TAMI-8, PARADIGM, IMPACT-AMI, and TIMI-14) have been equally encouraging.

Comment: Clear indications for the administration of glycoprotein IIb/IIIa receptor blockers in the ED are still being developed. Appropriate patient selection and timing of administration are under study, as is the concept of adding this therapy to thrombolysis for acute MI. Emergency physicians should learn more about these drugs because they will likely become a staple of therapy in the ED chest pain center. This article should be in everyone's library.

— CV Pollack

Published in Journal Watch Emergency Medicine February 1, 1999

Citation(s):

Gibler WB et al. Prospective use of glycoprotein IIb/IIIa receptor blockers in the emergency department setting. Ann Emerg Med 1998 Dec 32 712-722.

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