Oral platelet glycoprotein IIb/IIIa inhibition |
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Authors: | L Kristin Newby MD Darren K McGuire MD |
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Institution: | (1) Duke Clinical Research Institute, PO Box 17969, 27707-7969 Durham, NC, USA |
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Abstract: | Platelet aggregation plays a central role in the pathogenesis of thrombosis and the acute coronary syndromes. When given intravenously,
potent selective antagonists of fibrinogen binding to the glycoprotein (GP) IIb/IIIa receptor, the final common pathway for
platelet aggregation, have been effective in the treatment of acute coronary syndromes. Their benefit ceases, however, with
the end of the infusion. Aspirin reduces the incidence of secondary vascular events by 25% to 30% after an acute coronary
syndrome, and clopidogrel provides modest improvement over aspirin. However, both are relatively weak antiplatelet agents
that each block only one of many pathways to platelet activation and surface membrane expression of the competent GP IIb/IIIa
receptor. With the success of the intravenous GP IIb/IIIa antagonists in the acute setting, recent interest has focused on
the potential benefit of oral GP IIb/IIIa antagonists used long-term for secondary prevention. The oral agents tested in phase
III studies thus far have not performed up to expectations, however. The following paper reviews these studies and the implications
of their results. |
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