Prevention of cardiovascular ischemic complications with new platelet glycoprotein IIb/IIIa inhibitors.

Agents that block platelet glycoprotein IIb/IIIa integrin, the receptor that mediates the final common pathway of platelet aggregation, represent a promising new approach to preventing cardiovascular ischemic complications and late restenosis after percutaneous coronary revascularization. In the large-scale Evaluation of c7E3 for the Prevention of Ischemic Complications (EPIC) trial that involved high-risk patients undergoing coronary intervention procedures, a monoclonal antibody Fab fragment (c7E3) directed against this receptor, administered as a bolus and and through infusion, significantly reduced the 30-day incidence of major ischemic events relative to placebo. Treatment was associated with higher rates of bleeding complications and transfusion, the risk of which appeared to be inversely related to body weight. The c7E3 bolus and infusion also significantly decreased the need for repeat revascularization during the 6-month blinded follow-up period. Ongoing trials are now exploring strategies for refining the practical aspects of glycoprotein IIb/IIIa therapy and minimizing the risk of bleeding.