Upstream GP IIb/IIIa inhibitors in NSTEACS: Moving from acuity to early ACS
The results of randomized clinical trials on glycoprotein (GP) IIb/IIIa inhibitors performed in the past decade have established the use of this class of antiplatelet drug as part of the routine care of patients with non-ST-segment elevation ACS (NSTEACS). However, they have left several unanswered questions regarding patient selection, the use of concomitant or alternative antithrombotic therapies, and the optimal timing and strategy for GP IIb/IIIa inhibitor use. This review involves discussion of some of the most clinically relevant unresolved issues concerning the use of GP IIb/IIIa inhibitors in modern NSTEACS care, the design and results of the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) Timing trial, and the recently released guideline recommendations on the use of these agents in NSTEACS. Finally, attention is given to the key design features of the ongoing EARLY ACS (Early GP IIb/IIIa Inhibition in NSTEACS) trial, which is a critical study expected to provide a definitive answer on the benefit of upstream GP IIb/IIIa inhibition in patients with NSTEACS managed according to contemporary standards of care.
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