Acute management of ACS
Glycoprotein IIb/IIIa inhibitors in patients with acute coronary syndrome

Glycoprotein IIb/IIIa inhibitors (GPI) block the final common pathway in platelet aggregation. Data from several large randomized clinical trials have demonstrated that glycoprotein IIb/IIIa inhibitors reduce mortality and reinfarction in patients with acute coronary syndrome (ACS), particularly in patients undergoing subsequent percutaneous coronary intervention (PCI). Patients with unstable angina/non-ST-segment elevation myocardial infarction who are troponin-positive, have high-risk features or undergoing an early invasive approach should be initiated on GPI. Glycoprotein IIb/IIIa inhibitors are not recommended in patients with ST-segment elevation myocardial infarction when used in combination with fibrinolytic therapy, either as part of a facilitated regimen prior to primary PCI, or as a pharmacologic reperfusion regimen without planned PCI, due to an increased incidence of bleeding and the lack of improved clinical outcomes. Glycoprotein IIb/IIIa inhibitors appear to be most beneficial in patients with elevated troponin, recurrent ischemia and diabetes. Adequate dose adjustment for creatinine clearance is important to decrease the incidence of side effects such as bleeding and thrombocytopenia. Studies are ongoing to determine the optimal timing of initiation of GPI in patients with ACS and to further identify subgroups who derive greater benefit from GPI.