Review of currently available GP IIb/IIIa inhibitors and their role in peripheral vascular interventions

The glycoprotein IIb/IIIa (GP IIb/IIIa) antagonists are the most recent additions to the antiplatelet agents available to the interventional radiologist. The currently available GP IIb/IIIa antagonists are abciximab, eptifibatide, and tirofiban. These medications have demonstrated excellent safety and efficacy in the setting of coronary arterial interventions. The fundamental benefit of the GP IIb/IIIa antagonists lies in their unique mechanism of action: the ability to prevent platelet aggregation, thrombus formation, and distal thromboembolism while preserving initial platelet binding to damaged vascular surfaces. A paucity of data exists regarding the role of GP IIb/IIIa inhibitors in peripheral vascular interventions. The GP IIb/IIIa antagonists would theoretically provide excellent antiplatelet therapy in patients undergoing any of a variety of endovascular interventions during which thrombosis or thromboembolism may endanger distal perfusion in patients with peripheral vascular disease. The goal of this summary is to review the indications for use, pharmacology, and evidence for efficacy of the GP IIb/IIIa antagonists in hopes of translating these data for application in the peripheral arterial circulation. Further research is necessary to determine how these agents may be safely used in combination with other anticoagulants or with stents, efficacy compared with standard regimens, success at preventing distal thromboembolism, and cost effectiveness.