Glycoprotein (
GP) IIb/IIIa receptor antagonists inhibit the binding of
ligands to activated platelet
GP IIb/IIIa receptors and, therefore, prevent the formation of platelet thrombi. They have been extensively studied in patients undergoing
percutaneous coronary intervention (PCI).
Eptifibatide, one of the approved
GP IIb/IIIa inhibitors, is a small heptapeptide that is highly selective and rapidly dissociates from its receptor after cessation of
therapy. In clinical studies, concomitant administration of
eptifibatide in patients undergoing elective PCI reduced thrombotic complications in the IMPACT-II (
Integrilin to Minimize Platelet Aggregation and Prevent
Coronary Thrombosis II) and
ESPRIT (Enhanced Suppression of the Platelet IIb/IIIa Receptor with
Integrilin Therapy) trials. In the PURSUIT (
Platelet Glycoprotein IIb/IIIa in
Unstable Angina: Receptor Suppression Using
Integrilin Therapy) trial, which included 10,948 patients with non-ST-elevation
acute coronary syndromes,
eptifibatide significantly reduced the primary end point of death and non-fatal
myocardial infarction at 30 days compared with placebo. In patients with
ST-segment elevation myocardial infarction (
STEMI),
eptifibatide has been studied as adjunct to primary PCI and improved epicardial flow and tissue reperfusion. Studies are now evaluating
eptifibatide in high-risk patients with non-ST elevation
acute coronary syndromes (NSTE-ACS) and a planned early invasive strategy in the EARLY-ACS (
Eptifibatide Administration prior to Diagnostic Catherization and Revascularization to Limit Myocardial
Necrosis in
Acute Coronary Syndrome) trial and in patients with primary PCI for
STEMI in comparison to
abciximab in the EVA-AMI (
Eptifibatide versus
Abciximab in Primary PCI for Acute
Myocardial Infarction) trial. After the completion of these trials, the value of etifibatide in patients undergoing PCI in different indications can be determined.