Clinical management of unstable angina: the place of antithrombins and platelet GP IIb/IIIa receptor blockers.

Unstable angina is a clinical and anatomic mosaic in which platelet aggregation, thrombus formation and fixed and dynamic coronary artery restrictions play variable and changing roles. Emerging medical and mechanical options to deal with each of these components show promise. GP IIb/IIIa receptor blockade is a significant advance over aspirin as all pathways to platelet aggregation are blocked by the new agents. Whether the new antithrombins represent a major advance over heparin is less clear as prothrombin activation is not blocked and rebound is seen as a result. For these new antiplatelet and antithrombin medications, encouragement is based upon small trials. The initial impressions need to be confirmed in larger trials before the role of these expensive new agents can be defined.