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(Circulation. 2001;103:2528.)
© 2001 American Heart Association, Inc.

Editorial

Monitoring Platelet Function in Glycoprotein IIb/IIIa Inhibitor Therapy

Kenneth K. Wu, MD, PhD; James T. Willerson, MD

From the University of Texas Medical School at Houston (K.K.W.) and St Luke’s Episcopal Hospital/Texas Heart Institute (J.T.W.), Houston, Tex.

Correspondence to Kenneth Wu, MD, University of Texas Medical School at Houston, 6431 Fannin, MSB 5.016, Houston, TX 77030. E-mail Kenneth.K.Wu@uth.tmc.edu

Key Words: Editorials • platelets • glycoproteins

Platelet aggregation is a key step in thrombus formation on the ruptured atherosclerotic plaque and after percutaneous coronary intervention (PCI). It is induced and amplified by several potent agonists, such as collagen, ADP, thromboxane A₂, and thrombin. Each agonist binds to a specific platelet membrane receptor and signals the conformational change of glycoprotein IIb/IIIa (GP IIb/IIIa), which becomes an active receptor for fibrinogen. The binding of fibrinogen to GP IIb/IIIa mediates platelet aggregation.¹ At high shear stress, von Willebrand factor also binds to GP IIb/IIIa and contributes to platelet aggregation.² Thus, platelet surface GP IIb/IIIa plays a critical role in coronary arterial thrombosis and is a target for antithrombotic therapy.

Three classes of GP IIb/IIIa antagonists have been shown to be efficacious in reducing thrombotic events in patients with acute coronary syndromes. Abciximab is a "humanized" hybrid monoclonal antibody that binds to active GP IIb/IIIa, thereby blocking fibrinogen binding and subsequent platelet aggregation. Integrilin (eptifibatide) is a synthetic peptide containing a cyclic KGD (lysine-glycine-aspartic acid) sequence that blocks the GP IIb/IIIa complex without affecting the function of other integrins. Tirofiban is a nonpeptide GP IIb/IIIa receptor antagonist with a potent inhibitory effect on platelet aggregation.³ All 3 drugs (abciximab, eptifibatide, and tirofiban) have been shown by controlled, clinical trials to be beneficial in reducing thrombotic complications in patients with acute coronary artery syndromes who are treated with PCI.^{4 5 6} However, in each of these trials, many patients who received these treatments were not protected.

It has been suggested that the . . . [Full Text of this Article]

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