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Adjunctive Therapy
Principles Archive
2001
TCT 2002 Abstracts
ABC of antithrombotic therapy: Antithrombotic therapy in acute coronary
syndromes
Robert D S Watson, Bernard S P Chin, and Gregory Y H Lip
BMJ 2002; 325: 1348-1351. [Full
text] [PDF]
PowerPoint Presentations:
Antiplatelet therapy overview
Archive 1989-2001
*Review*
Antiplatelet and anticoagulant therapy in elective percutaneous coronary
intervention
Jurriėn M ten Berg, HW Thijs Plokker and Freek WA Verheugt
http://cvm.controlled-trials.com/content/2/3/129
Full text journal article Oct 2002
Combination Antiplatelet
Therapy: Implications for Pharmacists
The following two case reports involving patients who received suboptimal
antiplatelet therapy point out disparities between national guidelines
and actual clinical practice that led to undesirable consequences in both
patients.
Full text journal article Jul 2002
Preventing Subacute
Thrombosis
Patients should continue to receive optimal medical care despite the costs
or inconvenience of subacute thrombosis therapy.
Clopidogrel,
ticlopidine, aspirin Archive
1991-2001
Website
(Bristol-Myers Squibb/Sanofi Pharmaceuticals)
http://www.plavix.com/HCP/cardiology_index.jsp
AHA 2002 Meeting Coverage
CREDO
1-year results confirm benefit of long-term aspirin and clopidogrel therapy
after PCI
Steinhubl SR, et al.
JAMA 2002; 288:2411-2420.
with slides / Continuation of antiplatelet therapy with both aspirin and
clopidogrel for 1 year, as opposed to the current standard of 2 to 4 weeks,
leads to significant reductions in major thrombotic events among patients
undergoing elective PCI. The results were presented to coincide with their
publication in the Journal of the American Medical Association.
American Heart Association Scientific Sessions 2002. [ Nov 18, 2002 ]
CREDO: Clopidogrel
for the Reduction of Events During Observation - 1-year Follow-up Results
Following PCI, maintaining dual antiplatelet therapy with aspirin and
clopidogrel for up to 1 year significantly reduces the risk of adverse
thrombotic events by 26.9%.
TCT 2002 Abstracts
TCT 2002 Expert presentations
CREDO:
Clopidogrel before elective PCI cuts 1-month event risk
with slide / Clopidogrel, which solidified a role as primary therapy for
patients presenting with ACS in the recent CURE trial, appears to prevent
thrombotic complications when given before elective PCI. Preliminary findings
from a prospective, randomized trial showed that clopidogrel pretreatment,
with or without GP IIb/IIIa inhibition, significantly reduced the 28-day
clinical-event risk--as long as pretreatment lasted 6 to 24 hours.
CREDO: Clopidogrel
for Reduction of Events During Observation
Compared with placebo, the administration of clopidogrel 6 hours prior
to PCI reduces the risk of death, MI, and TVR.
Safety
of clopidogrel pre-bypass debated
Hongo et al, Khot et al.
J Am Coll Cardiol 2002; 40: 231-237, 218-219. [ Jul 19, 2002 ]
Two articles question the routine administration of clopidogrel in ACS
patients (recommended post-CURE) or before anticipated stent implantation,
mainly due to increased bleeding risk in patients who go on to early CABG.
However, their arguments are refuted by CURE investigators and another
leading cardiologist.
Clopidogrel
benefit consistent in ACS across all risk groups
Budaj A et al.
Circulation: published online before print September 24, 2002.
with slides / The relative benefit of clopidogrel is consistent in low,
intermittent and high-risk ACS patients, but the absolute benefit is still
greatest in the higher risk patients.
Antiplatelet effect of clopidogrel inhibited by atorvastatin
Lau WC et al.
Circulation 2002, published online before print November 25, 2002
http://www.theheart.org/documents/page.cfm?from=590001200&doc_id=33511
Clopidogrel appears to be activated by the same enzyme that metabolizes
several of the lipophilic statins, suggesting that a hydrophilic statin
may be preferable when the 2 agents are given together. As clopidogrel
is now recommended for all ACS patients, this could have an important
effect on the statin market.
Atorvastatin Reduces the Ability of Clopidogrel to Inhibit Platelet Aggregation:
A New Drug-Drug Interaction
Wei C. Lau, et al
Circulation 2003;107 32-37
http://circ.ahajournals.org/cgi/content/abstract/107/1/32?etoc
Full text journal article May 2002
Clopidogrel Treatment
Before Percutaneous Coronary Intervention Reduces Adverse Cardiac Events
Concomitant administration of aspirin, clopidrogrel, enoxaparin and eptifibatide
in ACS patients is safe and feasible.
Abstract
Ticlopidine versus
oral anticoagulation for coronary stenting
A Cochrane Review Abstract: Evidence Based Medicine reviews based primarily
on meta-analysis of controlled clinical trials.
Full text journal article May 2002
Safety and Efficacy
of Only 2 Weeks of Ticlopidine Therapy in Patients at Increased Risk of
Coronary Stent Thrombosis: Results From the Antiplatelet Therapy
The risk of stent thrombosis and other adverse events in patients treated
with ticlopidine for only 2 weeks is low.
Full text journal article Aug 2002
Take 2 Aspirin and
Call Me in the Morning -- Cardiologists SHOULD Be Saying It!
Find out about aspirin“s properties, its efficacy compared with other
agents, and new guidelines advocating its use.
Meta-analysis of randomized and registry comparisons of ticlopidine with
clopidogrel after stenting
Bhatt DL, et al.
J Am Coll Cardiol 2002;39:9-14
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11755280
Based on all available evidence from randomized clinical trials or
registries, clopidogrel, in addition to better tolerability and fewer
side effects, is at least as efficacious as ticlopidine in reducing MACE.
This finding may be due to the more rapid onset of an antiplatelet effect
seen with the loading dose of clopidogrel, which was used in most of these
studies, or to better patient compliance with clopidogrel therapy. Therefore,
clopidogrel plus aspirin should replace ticlopidine plus aspirin as the
standard antiplatelet regimen after stent deployment
Clopidogrel
treatment before percutaneous coronary intervention reduces adverse cardiac
events
Berglund U, et al.
J Invasive Cardiol 2002;14:243-6.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11983944
Clopidogrel treatment in addition to aspirin before PCI was associated
with a reduction of in-hospital adverse cardiac events. It was also safe
and cost-saving.
Comparison
of antiplatelet effect of loading dose of clopidogrel versus abciximab
during coronary intervention
Claeys MJ, et al.
Blood Coagul Fibrinolysis 2002;13:283-288.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12032392
A loading dose of 450 mg clopidogrel was found to be more effective
than the standard loading dose of 375 mg. Platelet aggregation during
coronary intervention is strongly inhibited by both abciximab and by high
loading dose of clopidogrel. Although abciximab showed a stronger antiplatelet
effect than clopidogrel, it remains to be established whether this ex
vivo superiority of abciximab also translates into an overall clinical
benefit in patients with elective stent implantation.
The thienopyridines
Lubbe DF, et al.
J Interv Cardiol 2002;15:85-93.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12053688
Widespread use of ticlopidine, the first available thienopyridine,
was limited by frequent side-effects, including life-threatening neutropenia
and thrombotic thrombocytopenic purpura. Following the introduction of
clopidogrel, a thienopyridine with an excellent safety profile, dual antiplatelet
therapy with aspirin and clopidogrel has become standard therapy following
coronary stent implantation and coronary VBT. In patients presenting with
ACS, the addition of clopidogrel to aspirin has now been proven to reduce
ischemic events. The most important limitation of dual antiplatelet therapy
is the increased bleeding risk as compared with aspirin alone, particularly
in patients undergoing coronary artery bypass grafting during the index
hospitalization. However, for many patients with ACS, combination therapy
is appropriate.
Use
of clopidogrel loading, enoxaparin, and double-bolus eptifibatide in the
setting of early percutaneous coronary intervention for acute coronary
syndromes
Miller L, et al.
J Invasive Cardiol 2002;14:247-50.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11983945
Patients received aspirin 325 mg orally, clopidogrel 300 mg orally,
enoxaparin 0.5 mg/kg intravenous (IV), and eptifibatide using the ESPIRIT
dosing (180 g/kg bolus IV, immediately followed by a 2 g/kg/minute continuous
IV infusion, and then a second 180 g/kg bolus IV ten minutes after the
first bolus). This pilot study demonstrates the feasibility of
administering aspirin, clopidogrel, enoxaparin, and eptifibatide in the
setting of percutaneous coronary intervention for acute coronary syndromes.
These agents can be administered moments before the coronary intervention
with no apparent compromise in patient safety.
Effect
of 300- and 450-mg clopidogrel loading doses on membrane and soluble P-selectin
in patients undergoing coronary stent implantation
Seyfarth HJ, et al.
Am Heart J 2002;143:118-23.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11773921
http://www.mosby.com/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=abs&id=a119372&target=
In our study the application of 450 mg of clopidogrel as the loading
dose in patients undergoing coronary stenting shortens the period until
the maximum effect of the ADP receptor antagonist is achieved and thus
may lead to a more successful prevention of subacute coronary stent thromboses.
Full text journal article Ago 2002
Randomized Comparison
of Cilostazol Versus Ticlopidine Hydrochloride for Antiplatelet Therapy
After
Coronary Stent Implantation for Prevention of Late Restenosis
Aspirin plus cilostazol therapy may be effective for the prevention of
not only stent thrombosis but also restenosis
When
increased therapeutic benefit comes at increased cost
Wood AJ.
N Engl J Med 2002;346:1819-21.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12050345
http://content.nejm.org/cgi/content/full/346/23/1819
What
is the optimum dose of aspirin for secondary prevention?
The question of what the optimum dose of aspirin is for the secondary
prevention of heart disease has been highlighted by an argument over this
issue between two drug companies. However, two researchers, who have both
conducted studies recently in this area, were in agreement that lower
doses of aspirin (between 75-150 mg) seemed equally effective in preventing
recurrent cardiovascular events than higher doses, and would probably
result in less gastric side effects. [ May 02, 2002 ]
GP IIb/IIIa Inhibitors
GP IIb-IIIa Overview
Archive 2000-2001
GP IIb-IIIa use in PCI - Free PowerPoint Slides
http://www.clinicaltrialresults.org/ua/interventional/pci_home.htm
TCT 2002 Meeting Coverage
Universal vs Selective
Use of Glycoprotein IIb/IIIa Inhibitors During Percutaneous Intervention
World-renowned experts discuss the role of GP IIb/IIIa inhibitors in the
cath lab and whether the drugs should be used in all ACS patients.
TCT 2002 Expert Presentations
TCT 2002 DEBATE: Do GP IIB/IIIA Inhibitors Reduce Mortality When Used
in PCI?
TCT 2002 Debates Expert presentations
Universal vs. Selective Use of Glycoprotein IIb/IIIa Inhibitors During
Percutaneous Intervention
Platelet glycoprotein
IIb/IIIa inhibitors in acute coronary syndromes: a meta-analysis of all
major randomised clinical trials
Boersma E, et al.
Lancet 2002;359:189-98.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11812552
Summary:
Full text journal article Jul 2002
Administration of
Glycoprotein IIb-IIIA Inhibitors in Patients with ST-Segment Elevation
Myocardial Infarction
Why is reperfusion therapy, either by mechanical or pharmacological means,
required immediately by these patients?
Full text journal article Sep 2002
Integrating GP IIb/IIIa
Inhibition into Treatment Strategies for Acute ST-Elevation Myocardial
Infarction
Against the background of established clinical benefit in non-ST segment
elevation acute coronary syndromes (ACS) and elective percutaneous revascularization,
recent trials examining the role of glycoprotein (GP) IIb/IIIa inhibition
in acute myocardial infarction (AMI) have been based on the rationale
that effective platelet inhibition is fundamental to reperfusion strategies
designed to restore myocardial perfusion, limit infarct size, and improve
survival.
CME Circle Jul 2002
Diabetes and Cardiovascular
Disease: The Role of the Glycoprotein IIb/IIIa Inhibitors CME
Up to 25% of patients referred for percutaneous coronary interventions
or revascularization have diabetes mellitus. Emerging evidence of the
extraordinary benefits of glycoprotein IIb/IIIa inhibitors in this patient
population is providing hope for more effective treatment options and
improved prognosis for patients coping with the cardiovascular complications
of diabetes.
Intravenous glycoprotein IIb/IIIa receptor antagonists
reduce mortality after percutaneous coronary interventions
E. Karvouni, D.G. Katritsis, J.P.A. Ioannidis
J Am Coll Cardiol 2003;41:26-32
Full text via ScienceDirect :
http://www.sciencedirect.com/science?_ob=GatewayURL&_origin=CONTENTS&_method=
citationSearch&_piikey=S0735109702026669&_version=1&md5=e0b5f8e686b8a026ea4248841cb257fa
In patients undergoing PCI, GP IIb/IIIa receptor antagonists confer
a significant and sustained decrease (20% to 30%) in the risk of death.
Editorials
Platelet Glycoprotein IIb/IIIa Inhibition and Atheroembolism During Bypass
Graft Angioplasty: A Cup Half Full
Dean J. Kereiakes
Circulation 2002;106 2994-2996
http://circ.ahajournals.org/cgi/content/full/106/24/2994?etoc
Lack of Benefit From Intravenous Platelet Glycoprotein
IIb/IIIa Receptor Inhibition as Adjunctive Treatment for Percutaneous
Interventions of Aortocoronary Bypass Grafts: A Pooled Analysis of Five
Randomized Clinical Trials
Marco Roffi et al
Circulation 2002;106 3063-3067
http://circ.ahajournals.org/cgi/content/abstract/106/24/3063?etoc
Intravenous platelet GP IIb/IIIa receptor inhibition does not improve
outcomes after PCI of bypass grafts. In the absence of mechanical emboli
protection, this procedure is associated with high incidence of death
and nonfatal ischemic events.
Gender
differences in clinical outcome after coronary artery stenting with use
of glycoprotein IIb/IIIa inhibitors
Iakovou I, et al.
Am J Cardiol 2002;89:976-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11950440
Summaries of important articles from major peer-reviewed journals
6-month
TARGET results published
TARGET investigators
Lancet 2002;360:355-360. [ Aug 01, 2002 ]
Although 6-month results show similar event rates for tirofiban and abciximab
in stent patients, abciximab remains the drug of choice because of its
early benefit.
Abciximab Archive
1993-2001
ReoPro Trials - Free PowerPoint Slides
http://www.clinicaltrialresults.org/ua/abciximab/abciximab_home.htm
ReoPro.com
http://www.reopro.com/
Web site with many resources: Science of ReoPro, Clinical trials, Multimedia
cases, Clinical experiences, Mini lectures, Speaker slides in PowerPoint
format, CME, Medical meetings
Access: No registration required
TCT 2002 Meeting Coverage
Assay-guided
abciximab bolus dosing worked, saved money in registry study
Giving only 70% of the standard abciximab bolus before PCI, as long as
a rapid assay says platelet suppression is adequate, is safe and effective
as well as cheaper overall, according to a prospective registry analysis.
Transcatheter Cardiovascular Therapeutics 2002. [ Oct 03, 2002 ]
Full text journal article Aug 2002
Educational Program
to Reduce Major Bleeding in Patients Undergoing Percutaneous
Coronary Interventions and Receiving Abciximab
Abciximab is a potent antiplate let agent that has been shown to significantly
reduce ischemic complications in patients undergoing percutaneous coronary
intervention (PCI).
Full text journal article Jan 2002
Prophylactic Abciximab
in Elective Coronary Stenting: Results of a Randomized Trial
Abciximab does not increase the rate of complications as compared to standard
adjuvant therapy.
Full text journal article Feb 2002
Abciximab Improves
6-Month Clinical Outcome After Rescue Coronary Angioplasty
Abciximab during rescue PTCA positively affects clinical outcome at 6
months.
Full text journal article Mar 2002
Potential Anaphylactic
Shock With Abciximab Readministration
This case demonstrates that anaphylaxis can occur with readministration,
even after standard allergy prophylaxis.
Full text journal article Aug 2002
Abciximab Therapy
Improves 1-Month Survival Rate in Unselected Patients With Acute
Myocardial Infarction Undergoing Routine Infarct Artery Stent Implantation
This study supports the use of abciximab therapy in nonselected patients
with AMI undergoing routine IRA stent implantation.
Full text journal article Apr 2002
Glycoprotein IIb-IIIa
Inhibition with Abciximab and Postprocedural Risk Assessment: Lessons
From the Evalution of Platelet IIb/IIIa Inhibitor for Stenting Trial and
Implication for Ad Hoc Use of Glycoprotein IIb-IIIa Antagonists
IIb/IIIa antagonism with abciximab is equally effective in reducing events
regardless of degree of risk after stenting.
Platelet
Glycoprotein IIb/IIIa Inhibitor Use During Percutaneous Coronary Intervention:
IIb or Not IIb, What is the Question?
Young JJ, et al.
J Invasive Cardiol 2002;14:404-10.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12082194
Currently, small molecule GP IIb/IIIa inhibitor, tirofiban (Aggrastat,
Merck & Company), which (similar to eptifibatide) is approved for
the medical therapy of patients with non-ST segment elevation acute coronary
syndromes (ACS), has not received indication for use in the PCI setting.
Although the clinical benefits of both abciximab and eptifibatide administered
at the time of PCI have been proven in randomized clinical trials, only
abciximab has demonstrated a late survival advantage in patients following
PCI. Evidence in support of the presence, magnitude and possible mechanisms
for abciximab survival advantage is herein reviewed.
Reduced
inhibition by abciximab in platelets with the PlA2 polymorphism
Wheeler GL, et al.
Am Heart J 2002;143:76-82.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11773915
http://www.mosby.com/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=abs&id=a119763&target=
PlA1/A2 platelets are less completely inhibited with abciximab, contributing
to the observed interindividual variability in platelet function inhibition.
Because the extent of platelet inhibition is an independent predictor
for the risk of major adverse coronary events after percutaneous coronary
intervention, the relative resistance of PlA2-positive platelets may contribute
to a less favorable outcome in these patients.
Facilitated
percutaneous intervention following combination therapy with reteplase
and abciximab for acute myocardial infarction
Weinstock BS.
J Invasive Cardiol 2002;14:100-4; quiz 104-5.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11818648
Diabetic
patients treated with abciximab and intracoronary stenting
Walton BL, et al.
Catheter Cardiovasc Interv 2002;55:321-5.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11870935
The trends toward improvement of mortality, surgical or percutaneous
revascularization, and cardiac readmissions suggest the effect of abciximab
may provide benefit for up to 9 months for higher-risk diabetic patients.
Bleeding
Complications of Platelet Glycoprotein IIb/IIIa Inhibitor Abciximab (ReoPro
)
Trivedi SM, et al.
J Invasive Cardiol 2002;14:423-5.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12082199
Studies of patients scheduled for percutaneous coronary intervention
with acute coronary syndrome have shown that the addition of intravenous
glycoprotein (GP) IIb/IIIa inhibitors to aspirin and heparin is associated
with a reduction in death or myocardial infarction compared to therapy
with aspirin and heparin alone. The principle safety issue with GP IIb/IIIa
inhibitors is the risk of bleeding, as the potent antiplatelet effect
of these drugs may adversely affect hemostasis. In addition, antagonists
of GP IIb/IIIa may increase the risk of thrombocytopenia. This is a case
report of abciximab-induced severe thrombocytopenia which led to fatal
intra-cranial hemorrhage.
Guidelines
for acute coronary syndrome without ST elevation
Toquero Ramos J, et al.
Lancet 2002;359:1349; discussion 1350.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11965311
Prophylactic
abciximab in elective coronary stenting: results of a randomized trial
Tamburino C, et al.
J Invasive Cardiol 2002;14:72-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11818641
The peri-procedural use of abciximab during implantation of long or
multiple overlapping coronary stents is safe and effective, as it does
not increase bleeding or vascular complications compared to standard heparin
anticoagulation and reduces the incidence of in-hospital adverse cardiac
events; moreover, abciximab improves 6-month clinical and angiographic
outcomes in such a complex setting.
Comparison
of angioplasty with stenting, with or without abciximab, in acute myocardial
infarction
Stone GW, et al.
N Engl J Med 2002;346:957-66.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11919304
http://content.nejm.org/cgi/content/full/346/13/957
http://content.nejm.org/cgi/content/abstract/346/13/957
At experienced centers, stent implantation (with or without abciximab
therapy) should be considered the routine reperfusion strategy.
Combined
glycoprotein IIb/IIIa receptor inhibition and low-dose fibrinolysis for
peripheral arterial thrombosis
Rocha-Singh KJ, et al.
Catheter Cardiovasc Interv 2002;55:457-60.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11948891
The simultaneous intra-arterial administration of abciximab in conjunction
with low-dose reteplase (< or = 0.5 U/hr) was safe in 13 patients;
2 patients experienced major hemorrhagic complication at a reteplase dose
of 1 U/hr. The primary success rate was 100%; all patients experienced
an excellent clinical response with no clinical evidence of distal embolization.
No patient required repeat endovascular or surgical revascularization
during mean follow-up of 9.3 months. This promising new thrombolytic strategy
for the treatment of peripheral arterial occlusive disease requires further
study.
Abciximab
suppresses the rise in levels of circulating inflammatory markers after
percutaneous coronary revascularization
Ray KK.
Circulation 2002;105:e74.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11914269
http://www.circulationaha.org/cgi/content/full/105/12/e74
Abciximab
improves 6-month clinical outcome after rescue coronary angioplasty
Petronio AS, et al.
Am Heart J 2002;143:334-41.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11835040
http://www.mosby.com/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=abs&id=a119762&target=
Treatment with abciximab during rescue PTCA positively affects clinical
outcome at 6-month follow-up without increasing periprocedural bleeding.
Determination
of platelet aggregation inhibition during percutaneous coronary intervention
with the platelet function analyzer PFA-100
Madan M, et al.
Am Heart J 2002;144:151-8.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12094202
http://www.mosby.com/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=abs&id=a123581&target=
PFA-100 is a rapid simple assay used as a means of assessing inhibition
of platelet aggregation during PCI performed with glycoprotein IIb/IIIa
inhibition. The platelet function analyzer PFA-100 (Dade-Behring, Deerfield,
Ill) measures platelet function by determining the time to occlusion of
an aperture in a biochemically active membrane as whole blood flows under
high shear conditions. Failure to achieve nonclosure early after the initiation
of abciximab therapy warrants further investigation because there may
be an association with adverse cardiac events at 6-month follow-up.
Clinical
Pharmacokinetics of Tirofiban, a Nonpeptide Glycoprotein IIb/IIIa Receptor
Antagonist: Comparison with the Monoclonal Antibody Abciximab
Kondo K, et al.
Clin Pharmacokinet 2002;41:187-95
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11929319
This review updates what is known about the pharmacokinetics of tirofiban
in humans, especially in comparison with the monoclonal antibody against
the IIb/IIIa receptor, abciximab.
Myocardial
salvage after coronary stenting plus abciximab versus fibrinolysis plus
abciximab in patients with acute myocardial infarction: a randomised trial
Kastrati A, et al.
Lancet 2002;359:920-5.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11918909
In patients with acute myocardial infarction, a reperfusion strategy
based on stenting with abciximab produced more myocardial salvage than
the combination of fibrinolysis plus abciximab. Larger studies are needed
to assess whether these effects translate into clinical benefit.
Comparison
of efficacy and complication rates after percutaneous coronary interventions
in patients with and without renal insufficiency treated with abciximab
Frilling B, et al.
Am J Cardiol 2002;89:450-2.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11835927
Pharmacodynamic
profile of short-term readministration of abciximab in healthy subjects
Freedman J, et al.
Am Heart J 2002;143:87-94.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11773917
http://www.mosby.com/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=abs&id=a119769&target=
A fraction of the bolus of abciximab restored pharmacologic (>80%)
GP IIb/IIIa receptor blockade when readministered at various postinfusion
time points. These observations suggest that in the setting where acute
readministration of abciximab is required less than a full bolus dose
of the agent is warranted.
Initial
experience with the combination of reteplase and abciximab for thrombolytic
therapy in peripheral arterial occlusive disease: a pilot study
Drescher P, et al.
J Vasc Interv Radiol 2002;13:37-43.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11788692
http://www.jvir.org/cgi/content/full/13/1/37
http://www.jvir.org/cgi/content/abstract/13/1/37
The combination of reteplase and abciximab in catheter-directed arterial
thrombolysis is feasible and effective. This combination therapy pilot
study suggests short thrombolysis times and minimal adverse effects in
catheter-directed thrombolytic therapy for peripheral arterial occlusive
disease.
Optimizing
glycoprotein IIb/IIIa inhibition: lessons from recent randomized controlled
trials
Chew DP, et al.
Intern Med J 2002;32:338-45.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12088354
Recent randomized clinical trials with intravenous glycoprotein IIb/IIIa
inhibition have provided unanticipated results, thereby questioning their
role as empirical medical management for acute coronary syndromes. The
lack of benefit with abciximab observed in GUSTO IV is somewhat inconsistent
with the benefits seen with this agent in coronary intervention, and the
benefits of an early invasive approach incorporating tirofiban seen within
TACTICS-TIMI 18. Additionally, a direct 'head-to-head' comparative study
of abciximab and tirofiban within the setting of percutaneous coronary
intervention demonstrates clinically relevant superiority with abciximab
with respect to 30-day outcomes. in the setting of coronary instability
and mechanical plaque disruption is more complex than initially perceived.
Hence, although an abundance of evidence details the efficacy of these
agents, their optimal clinical application remains somewhat challenging
in light of these recent data. However, within the context of previous
trial experience, the current evidence highlights several key aspects
of glycoprotein IIb/IIIa inhibitor therapy that may be associated with
improved patient outcomes. In particular, these trials indicate: (i) the
importance of selecting high-risk patients in whom substantial clinical
benefit is evident, (ii) the incorporation of these agents into an early
invasive strategy, thereby matching the timing of vascular injury with
maximal platelet inhibition and (iii) optimal dosing to achieve the high
levels of platelet inhibition that appear to be required for efficacy
with these agents.
Long-term
mortality benefit with the combination of stents and abciximab for cardiogenic
shock complicating acute myocardial infarction
Chan AW, et al.
Am J Cardiol 2002;89:132-6.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11792330
Treatment with the combination of stent and abciximab resulted in
higher procedural Thrombolysis In Myocardial Infarction 3 flow rates and
a long-term mortality benefit in patients with cardiogenic shock complicating
acute myocardial infarction.
Editorial
Mechanical reperfusion therapy for acute myocardial infarction: Stent
PAMI, ADMIRAL, CADILLAC and beyond
Brodie BR, et al.
Heart 2002;87:191-2.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11847146
http://heart.bmjjournals.com/cgi/content/full/87/3/191
Abciximab
attenuates coronary microvascular endothelial dysfunction after coronary
stenting
Aymong ED, et al.
Circulation 2002;105:2981-5.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12081991
http://www.circulationaha.org/cgi/content/full/105/25/2981
http://www.circulationaha.org/cgi/content/abstract/105/25/2981
Abciximab preserves the Coronary blood flow (CBF) response to acetylcholine
(Ach) after coronary stenting. The preservation of microvascular endothelial
function may help explain the beneficial clinical effect of this agent
in patients undergoing PCI.
Eptifibatide Archive
2000-2001
Integrilin Trials - Free PowerPoint Slides
http://www.clinicaltrialresults.org/ua/integrilin/integrilin.htm
COR Therapeutics - INTEGRILIN®
http://www.corr.com
Treatment effects of eptifibatide in planned coronary stent implantation
in patients with chronic kidney disease (ESPRIT Trial)
Reddan DN, et al.
Am J Cardiol 2003;91:17-21
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12505565
Objective: explore the associations of creatinine clearance (CrCl) with
outcomes in a trial of eptifibatide therapy in patients who underwent
percutaneous coronary intervention (PCI). The treatment effect of eptifibatide
is realized regardless of renal function and trends toward being greater
in patients with mild renal impairment.
In-hospital costs of coronary stent implantation with and without eptifibatide
(the ESPRIT Trial). Enhanced Suppression of the Platelet IIb/IIIa Receptor
with Integrilin
Cohen DJ, et al.
Am J Cardiol 2002;89:61-4
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11779525
Safety of concomitant therapy with eptifibatide and enoxaparin in patients
undergoing percutaneous coronary intervention: Results of the coronary
revascularization using integrilin and single bolus enoxaparin study
D.L. Bhatt, B.I. Lee, P.J. Casterella, M. Pulsipher, M. Rogers, M. Cohen,
V.E. Corrigan, T.J. Ryan, J.A. Breall, J.W. Moses, G.M. Eaton, M.A. Sklar,
A.M. Lincoff
J Am Coll Cardiol 2003;41:20-25
Full text via ScienceDirect :
http://www.sciencedirect.com/science?_ob=GatewayURL&_origin=CONTENTS&_method=c
itationSearch&_piikey=S0735109702026311&_version=1&md5=14b26d6078f917c1c6ba19bf8a08935c
Compared with unfractionated heparin plus eptifibatide, the combination
of enoxaparin plus eptifibatide is not associated with an excess of bleeding
or vascular complications, including in those receiving closure devices.
Despite no monitoring of anticoagulation activity with enoxaparin, there
was no apparent increase in angiographic or clinical complications.
Same-day transradial
outpatient stenting with a 6-hr course of glycoprotein IIb/IIIa receptor
blockade: a feasibility study
Gilchrist IC, et al.
Catheter Cardiovasc Interv 2002;56:10-3.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11979524
Outpatient stent placement with 6-hr infusion of GP IIb/IIIa inhibitor
appears feasible and efficient in select patients. There may be challenges
to meet with regard to patient education. Further studies with larger
populations are needed to evaluate and optimize this approach
Gender differences
in clinical outcome after coronary artery stenting with use of glycoprotein
IIb/IIIa inhibitors
Iakovou I, et al.
Am J Cardiol 2002;89:976-9.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11950440
Pharmacodynamic
profile of the direct thrombin antagonist bivalirudin given in combination
with the glycoprotein IIb/IIIa antagonist eptifibatide
Kleiman NS, et al.
Am Heart J 2002;143:585-93.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11923794
http://www.mosby.com/scripts/om.dll/serve?action=searchDB&searchDBfor=art&artType=abs&id=a120297&target=
The findings of this study show the feasibility of combining the direct
thrombin antagonist bivalirudin with a potent antagonist of platelet glycoprotein
IIb-IIIa. Clinical trials are needed to assess the safety and efficacy
of this combination.
Reversible
thrombocytopenia associated with eptifibatide
Yoder M, et al.
Ann Pharmacother 2002;36:628-30.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11918511
http://journals.allenpress.com/jrnlserv/?request=get-abstract&issn=1060-0280&volume=36&issue=4&page=628
The temporal relationship to administration and the resolution of
the adverse reaction on discontinuation of the drug support the likelihood
that the severe, reversible thrombocytopenia was associated with eptifibatide.
A structural
and dynamic investigation of the facilitating effect of glycoprotein IIb/IIIa
inhibitors in dissolving platelet-rich clots
Collet JP, et al.
Circ Res 2002;90:428-34.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11884372
http://www.circresaha.org/cgi/content/full/90/4/428
http://www.circresaha.org/cgi/content/abstract/90/4/428
The results of this study demonstrate that fibrinolysis resistance
of platelet-rich clots (PRCs) is related primarily to the heterogeneity
in the clot structure between platelet-rich and platelet-poor areas. GP
IIb/IIIa inhibitors facilitate the rate and the extent of fibrinolysis
by improving rtPA binding velocity and, subsequently, the lysis rate in
platelet-rich areas. These findings provide new insights on the synergistic
potential of GP IIb/IIIa inhibitors and fibrinolytic agents.
Platelet aggregation
inhibitors for use in peripheral vascular interventions: what can we learn
from the experience in the coronary arteries?
Shlansky-Goldberg R.
J Vasc Interv Radiol 2002;13:229-46.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11875083
http://www.jvir.org/cgi/content/full/13/3/229
http://www.jvir.org/cgi/content/abstract/13/3/229
Because the majority of investigations have been performed in patients
undergoing coronary interventions, knowledge of these data is necessary
to attempt to translate the use of these antiplatelet drugs to peripheral
vascular interventions. The goal of this article is to review the use
of these agents in the percutaneous treatment of coronary artery disease
and give insight to their potential utility in noncoronary interventions.
Long-term
efficacy of platelet glycoprotein IIb/IIIa integrin blockade with eptifibatide
in coronary stent intervention
O'Shea JC, et al.
Jama 2002;287:618-21.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11829701
Long-term outcomes of nonurgent coronary stent implantation appear
to be improved through blockade of the platelet glycoprotein IIb/IIIa
integrin with eptifibatide. Although the mechanism behind these
results remains unclear, similarities between eptifibatide's benefits
and those of abciximab suggest a class effect.
ESPRIT 1-year results published
Comment
Platelet glycoprotein IIb/IIIa
inhibitor effect examined in 2 studies
SoRelle R.
Circulation 2002;105:E9067-8.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11826859
Eptifibatide
and low-dose tissue plasminogen activator in acute myocardial infarction:
the integrilin and low-dose thrombolysis in acute myocardial infarction
(INTRO AMI) trial
Brener SJ, et al.
J Am Coll Cardiol 2002;39:377-86.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11823073
In comparison with standard t-PA regimen, double-bolus eptifibatide
(10 min apart) with a 48-h infusion and half-dose t-PA (Group II) is associated
with improved quality and speed of reperfusion. The safety profile of
this therapy is similar to that of other combination regimens.
Patients with
acute coronary syndromes without persistent ST elevation undergoing percutaneous
coronary intervention benefit most from early intervention with protection
by a glycoprotein IIb/IIIa receptor blocker
Ronner E, et al.
Eur Heart J 2002;23:239-46.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11792139
Patients treated with a platelet glycoprotein IIb/IIIa receptor blocker,
and early percutaneous coronary intervention (within 24 h) had the lowest
event rate in this post hoc analysis. Thus 'watchful waiting' may not
be the optimal strategy. Rather an early invasive strategy with percutaneous
coronary intervention under protection of a platelet glycoprotein IIb/IIIa
receptor blocker should be considered in selected patients. Randomized
trials are warranted to verify this issue.
In-hospital
costs of coronary stent implantation with and without eptifibatide (the
ESPRIT Trial). Enhanced Suppression of the Platelet IIb/IIIa Receptor
with Integrilin
Cohen DJ, et al.
Am J Cardiol 2002;89:61-4.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11779525
Tirofiban Archive
1996-2001
Aggrastat Trials - Free PowerPoint Slides
http://www.clinicaltrialresults.org/ua/aggrastat/aggrastat_home.htm
Aggrastat.com
www.aggrastat.com
Website for Aggrastat ® (tirofiban HCI).
Access: No registration required
Features: Educational material with Instructional video online. Treatment
pathway and strategies.
ESC 2002 Meeting Coverage
Tirofiban
dose not high enough
The dose of tirofiban currently recommended does not give adequate platelet
inhibition for optimal effects, a new study shows.
European Society of Cardiology Congress 2002 [ Sep 06, 2002 ]
Comparison
of degree of platelet inhibition by abciximab versus tirofiban in patients
with unstable angina pectoris and non-Q-wave myocardial infarction undergoing
percutaneous coronary intervention
Herrmann HC, et al.
Am J Cardiol 2002;89:1293-7.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12031731
Suboptimal
early inhibition of platelets by treatment with tirofiban and implications
for coronary interventions
Kabbani SS, et al.
Am J Cardiol 2002;89:647-50.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11867064
Eptifibatide
and 7E3, but not tirofiban, inhibit alpha(v)beta3 integrin- mediated binding
of smooth muscle cells to thrombospondin and prothrombin
Scarborough RM.
Circulation 2002;105:e46.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11839641
http://www.circulationaha.org/cgi/content/full/105/6/e46
Impact of
clinical syndrome acuity on the differential response to 2 glycoprotein
IIb/IIIa inhibitors in patients undergoing coronary stenting: the TARGET
Trial
Stone GW, et al.
Circulation 2002;105:2347-54.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12021219
http://www.circulationaha.org/cgi/content/full/105/20/2347
http://www.circulationaha.org/cgi/content/abstract/105/20/2347
In patients with ACS undergoing stent implantation, abciximab use
compared with tirofiban results in greater suppression of periprocedural
myonecrosis, although a survival benefit has not been demonstrated. Patients
with stable coronary syndromes may have equivalent or better outcomes
with tirofiban relative to abciximab, with fewer adverse hematologic and
hemorrhagic events. These data raise important issues regarding the relative
pharmacodynamic inhibition of platelet function required in varying clinical
scenarios and have important implications for the cost-effective utilization
of glycoprotein IIb/IIIa inhibitors.
Oral Gp IIb/IIIa blockers
Archive 2000-2001
Review
Oral glycoprotein IIb/IIIa inhibitors increase mortality and myocardial
infarction
ACP Journal Club. 2002 Nov-Dec;137:85.
http://www.acpjc.org/Content/137/3/issue/ACPJC-2002-137-3-085.htm
Studies were identified by searching MEDLINE (1998 to 2001); reviewing
abstracts from American College of Cardiology, European Society of Cardiology,
and American Heart Association scientific sessions (1998 to 2001); and
contacting investigators in the field.
The results of the meta-analysis by Newby and colleagues are consistent
with other summaries. Oral GP IIb/IIIa inhibitors have not only failed
to reduce late ischemic events, they are associated with a consistent
excess in death and MI.
Review
The failure of orally administered glycoprotein
IIb/IIIa inhibitors to prevent recurrent cardiac events
Newby LK, Califf RM, White HD, et al.
Am J Med. 2002 Jun 1;112:647-58.
[PubMed
ID: 12034415]
Miscellaneous Archive
1987-2001
AHA 2002 Meeting Coverage
REPLACE-2
results: Will bivalirudin replace GP IIb/IIIa blockers in PCI?
UPDATED / with slides / Bivalirudin reduced major bleeding compared with
heparin plus IIb/IIIa blockers in PCI patients in the REPLACE-2 study,
but this benefit was offset somewhat by a nonsignificant increase in major
events.
American Heart Association Scientific Sessions 2002. [ Nov 17, 2002 ]
REPLACE-2:
Randomized Evaluation of PCI Linking Angiomax to Reduced Clinical Events
The results indicate that bivalirudin is superior to heparin alone and
is noninferior to heparin plus GP IIb/IIIa inhibitor therapy.
Italian
Studio
REPLACE-2: valutazione randomizzata dell'interventistica
percutanea in associazione ad angiomax nella riduzione degli eventi clinici
Luis Gruberg, MD
An
Update on Angiomax presented by The Medicines Co.
Slide presentations include:
TCT 2002 Expert Presentations
TCT 2002 DEBATE: Heparinization (Without GP IIb/IIIa Inhibitors) in
PCI - Does ACT Matter?
ACC 2002 Meeting Coverage
Summaries of important articles from major peer-reviewed journals
Full text journal article May 2002
Bivalirudin With
Planned or Provisional Abciximab Versus Low-Dose
Heparin and Abciximab During Percutaneous Coronary Revascularization
Bivalirudin with abciximab may be at least as safe and effective as low-dose
heparin plus abciximab during PCI.
Full text journal article Ago 2002
Bivalirudin: A Direct
Thrombin Inhibitor for Percutaneous Transluminal Coronary Angioplasty
Coronary artery disease affects more than 7 million Americans and accounts
for more than 500,000 deaths/year in the United States.
Full text journal article Ago 2002
Stable and Optimal
Anticoagulation is Achieved With a Single Dose of
Intravenous Enoxaparin in Patients Undergoing Percutaneous Coronary Intervention
Intravenous enoxaparin is safe and has a stable therapeutic anticoagulant
effect within 4 hours of administration.
Full text journal article Jun 2002
Point-of-Care Versus
Laboratory Monitoring of Patients Receiving Different Anticoagulant Therapies
This study compares point-of-care and standard hospital laboratory assays
for monitoring anticoagulant regimens.
Full text journal article Oct 2002
Low Molecular Weight
Heparin Therapy for Non-ST-Elevation Acute
Coronary Syndromes and During Percutaneous Coronary Intervention: An Expert
Consensus
In patients with unstable angina (UA) and non-ST-elevation myocardial
infarction (NSTEMI), new pharmacologic agents and improved revascularization
techniques have reduced morbidity and mortality rates.
Full text journal article Aug 2002
Randomized Double-Blind
Safety Study of Enoxaparin Versus Unfractionated Heparin in Patients With
Non-ST-Segment Elevation Acute Coronary Syndromes Treated With Tirofiban
and Aspirin: The ACUTE II Study
Despite the use of numerous antithrombotic agents in patients with unstable
angina or non-ST-segment elevation myocardial infarction (UA/NSTEMI) syndromes,
this patient population continues to demonstrate a risk of ischemic complications.
Efficacy and safety of minimal dose (</=1,000 Units) unfractionated
heparin with abciximab in percutaneous coronary intervention
Denardo SJ, et al.
Am J Cardiol 2003;91:1-5
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=12505562
In the context of historical data, the efficacy and safety of PCI using
either stent deployment or high-speed rotational atherectomy is maintained,
if not improved, when performed using abciximab accompanied by only minimal
doses of unfractionated heparin.
Comparison of Enoxaparin Versus Unfractionated Heparin
in Patients With Unstable Angina Pectoris/Non-ST-Segment Elevation Acute
Myocardial Infarction Having Subsequent Percutaneous Coronary Intervention
Fox KA, Antman EM, Cohen M, Bigonzi F, the ESSENCE/TIMI 11B Investigators
American Journal of Cardiology. 2002;90(5):477-482
http://www.medscape.com/viewarticle/443185_3
The present ad hoc analysis, albeit despite the known limitations, presents
data that are consistent with the evidence accumulated in previous smaller
clinical trials and suggests that treatment with the LMWH enoxaparin is
safe, effective, and well tolerated in UA/NSTEMI patients who undergo
PCI. Furthermore, this drug is safe and effective in these patients regardless
of whether they undergo PCI. As suggested by the authors, ongoing trials
such as SYNERGY (Superior Yield of the New Strategy of Enoxaparin, Revascularization
& GlYcoprotein IIb/IIIa Inhibitors) will compare again these same
drugs in high-risk patients likely to undergo PCI and provide a definite
answer.
Mortality Benefit of Beta-Blockade After Successful
Elective Percutaneous Coronary Intervention
Chan AW, Quinn MJ, Bhatt DL, et al.
Journal of The American College of Cardiology. 2002;40(4):669-675
http://www.medscape.com/viewarticle/441576_2
The present study shows that, in patients undergoing successful PCI,
beta-blocker therapy should be considered and implemented concurrently,
especially in high-risk patients who are not generally considered candidates
for treatment, including patients with diabetes, reduced left ventricular
function, chronic renal insufficiency, peripheral vascular disease, and
multivessel coronary artery disease.
S-Nitrosoglutathione Reduces Asymptomatic Embolization
After Carotid Angioplasty
Zoltan Kaposzta et al
Circulation 2002;106 3057-3062
http://circ.ahajournals.org/cgi/content/abstract/106/24/3057?etoc
S-Nitrosoglutathione was highly effective in rapidly reducing the
frequency of embolic signals after endovascular treatment for symptomatic
high-grade carotid stenosis.
Randomized,
placebo-controlled trial of titrated intravenous lamifiban for acute coronary
syndromes
PARAGON Investigators
Circulation 2002;105:316-21.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11804986
http://www.circulationaha.org/cgi/content/full/105/3/316
http://www.circulationaha.org/cgi/content/abstract/105/3/316
Lamifiban showed no significant effects on clinical outcomes in patients
with non-ST-elevation acute coronary syndromes, despite achievement of
adequate plasma concentrations
Comparison
of degree of platelet inhibition by abciximab versus tirofiban in patients
with unstable angina pectoris and non-Q-wave myocardial infarction undergoing
percutaneous coronary intervention
Herrmann HC, et al.
Am J Cardiol 2002;89:1293-7.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=12031731
Clinical Pharmacokinetics
of Tirofiban, a Nonpeptide Glycoprotein IIb/IIIa Receptor Antagonist:
Comparison with the Monoclonal Antibody Abciximab
Kondo K, et al.
Clin Pharmacokinet 2002;41:187-95
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=11929319
This review updates what is known about the pharmacokinetics of tirofiban
in humans, especially in comparison with the monoclonal antibody against
the IIb/IIIa receptor, abciximab.
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