The role of platelet glycoprotein IIb/IIIa antagonists in percutaneous coronary revascularization procedures

Platelet activation occupies a central role in arterial thrombosis after vascular injury, and the platelet glycoprotein (GPIIb/IIIa integrin mediates the final common pathway for platelet aggregation. Agents of the recently developed pharmacologic class of inhibitors of the platelet GPIIb/IIIa receptor have been shown to decrease ischemic complications after coronary revascularization procedures. However, several issues need to be determined with respect to their specific indications, dosage, and combination with other antithrombotic therapies. Intracoronary thrombus formation during percutaneous coronary interventions (PCI) is the main pathogenic mechanism of the acute complications of PCI, but has also been implicated in the pathogenesis of their long-term results. In order to target intracoronary thrombosis, all PCIs have been performed during intense short-term anticoagulation with combination of unfractionated heparin plus aspirin. Compelling data on the central role of platelets in arterial thrombosis have made apparent the need for more potent antiplatelet agents for the treatment of patients undergoing PCI.