Abciximab (ab sik si mab; ReoPro - Centocor), the Fab (fragment antigen binding) fragment of the chimeric human-murine monoclonal antibody 7E3 (c7E3 Fab), has been approved by the US Food and Drug Administration as an adjunct to percutaneous transluminal coronary angioplasty or atherectomy (PTCA) to prevent abrupt closure of the treated coronary vessel.

Two new platelet glycoprotein IIb/IIIa receptor antagonists have been approved for marketing by the US Food and Drug Administration (FDA). Eptifibatide (ep ti fi' ba tyde; Integrilin - Cor, Key) is approved for use in acute coronary syndromes (unstable angina or non-Q-wave myocardial infarction) or percutaneous coronary intervention (angioplasty or atherectomy). Tirofiban (tye roe fye' ban; Aggrastat - Merck) is approved for acute coronary syndromes, but not for angioplasty without an acute coronary syndrome. Abciximab (ReoPro), a monoclonal antibody glycoprotein IIb/IIIa receptor...

Percutaneous coronary intervention (PCI), such as balloon angioplasty or stent placement, predisposes to subsequent thrombosis. The current pharmacologic approach to prevention of this problem combines an anticoagulant with one or more antiplatelet drugs.

The antiplatelet agents aspirin and clopidogrel (Plavix, and others) are used in most patients undergoing percutaneous coronary intervention (PCI) to prevent stent thrombosis and to reduce the occurrence of peri-, post-procedural and late cardiovascular events. Despite a large number of randomized trials of these agents in such patients, the optimal dosage and duration of treatment with these drugs, and whether other drugs should be added, is unclear.

The FDA has required manufacturers of the oral P2Y₁₂ platelet inhibitors clopidogrel (Plavix, and generics), prasugrel (Effient, and generics), and ticagrelor (Brilinta) to warn in the product labels that the absorption of these drugs may be delayed or reduced when taken with an opioid agonist.

Bivalirudin is being promoted as an intravenous (IV) anticoagulant that can be used instead of heparin in patients with unstable angina undergoing coronary angioplasty.

Tenecteplase, a recombinant variant of human tissue plasminogen activator, is now available for thrombolysis in patients with acute myocardial infarction.

Antiplatelet drugs are the drugs of choice for prevention and treatment of arterial thrombosis. Anticoagulants are the drugs of choice for prevention and treatment of venous thromboembolism and for prevention of cardioembolic events in patients with atrial fibrillation.