The role played by
glycoprotein (
GP) IIb/IIIa inhibitors has continuously evolved from the initial introduction in mid 90 s until the most recent guidelines for treating
acute coronary syndromes, and competed with a wider use of
ADP inhibitors and novel
anticoagulant drugs, to the extent that they stepped down from class I to class II recommendation in the routine setting of
acute coronary syndromes. As a consequence,
GP IIb/IIIa use was greatly narrowed. The purpose of this review is to define the roles that
GP IIb/IIIa inhibitors may still have in acute ischemic settings by explaining why in high risk patients they might be preferable and/or whether they might be added to
ADP inhibitors also emphasizing the underlying mechanistic actions. It is concluded that there might be a more extensive use of
GP IIb/IIIa inhibitors in patients presenting with
acute coronary syndromes, strictly based on the definition for a high risk procedure: complexity, angiographic characteristics and patient's risk profile, regardless whether
STEMI or
NSTEMI. The positive elements one should appreciate in
GP IIb/IIIa inhibitors are: efficacy, rapid onset and reversibility of action, absence of pharmacogenomic variability, pharmacoeconomic considerations and the possibility of intracoronary administration.