Upstream Antiplatelet Therapy in ST-Segment Elevation Myocardial Infarction: What Zalunfiban Adds to the Glycoprotein IIb/IIIa Story

Zalunfiban is a next-generation glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitor developed through a novel molecular design that enables rapid, potent, and reversible platelet inhibition following single-dose subcutaneous administration. This pharmacologic profile creates an opportunity for very early antiplatelet therapy at first medical contact in patients with ST-segment elevation myocardial infarction. Historical experience with intravenous GPIIb/IIIa inhibitors has demonstrated that clinical benefit is highly dependent on early administration; however, routine prehospital use has been limited by logistical complexity and safety concerns. Recent clinical trials suggest that zalunfiban may overcome these barriers while preserving the mechanistic advantages of upstream platelet inhibition. This review summarizes the mechanism of action, pharmacokinetic and pharmacodynamic properties, clinical efficacy, and safety profile of zalunfiban, and discusses its potential role within contemporary ST-segment elevation myocardial infarction care pathways.