Achieved platelet aggregation inhibition after different antiplatelet regimens during percutaneous coronary intervention for ST-segment elevation myocardial infarction

Ernst, Nicolette; Suryapranata, Harry; Miedema, Kor; Slingerland, Robbert J.; Ottervanger, Jan Paul; Hoorntje, Jan C.A.; Gosselink, A T Marcel; Dambrink, Jan‐Henk E.; Boer, Menko‐Jan de; Zijlstra, Felix; Hof, Arnoud W J van ‘t

doi:10.1016/j.jacc.2004.06.050

Cited by 95 publications

(67 citation statements)

References 21 publications

(19 reference statements)

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“…6,15,17,18,20,21,23,26,28,29 The incidence of minor bleeding at 30 days was 5.5% with GPIs versus 4.1% with control (RR = 1.37; 95% CI, 1.06-1.78; P = 0.016) (Supporting Information Figure 3). No publication bias was detected (Begg's test P = 0.53, Egger's test P = 0.41) and heterogeneity was low (I 2 = 13.5%).…”

Section: Safetymentioning

confidence: 99%

“…6,17,20,21,23,24,28,29 Neither abciximab (RR = 1.99; 95% CI, 0.70-5.68; P = 0.20), nor the small molecule GPIs (RR = 0.98; 95% CI, 0.35-2.74; P = 0.98) were independently associated with thrombocytopenia. Stroke data were available for 5 studies and was not significantly different between GPIs and control (RR = 0.37; 95% CI, 0.13-1.08; P = 0.068).…”

Section: Safetymentioning

confidence: 99%

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Efficacy and Safety of Unfractionated Heparin Plus Glycoprotein IIb/IIIa Inhibitors During Revascularization for an Acute Coronary Syndrome: A Meta‐Analysis of Randomized Trials Performed With Stents and Thienopyridines

Winchester

Brearley

Wen

et al. 2011

Clinical Cardiology

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Background: Early studies of glycoprotein IIb/IIIa inhibitors (GPIs) demonstrated benefit during percutaneous coronary intervention for acute coronary syndromes (ACS). Since their introduction, the magnitude of benefit of GPIs has become unclear. Hypothesis: We hypothesized that adding a GPI to unfractionated heparin in ACS patients treated with stents and thienopyridines is beneficial. Methods: We searched the MEDLINE, Cochrane, and clinicaltrials.gov databases for randomized clinical trials that studied the use of GPIs during ACS. We required that patients be randomly assigned to unfractionated heparin plus a GPI versus unfractionated heparin plus placebo (or control). Additional inclusion criteria included the use of coronary stents and periprocedural thienopyridines. Outcomes were assessed at 30 days. Random effects DerSimonian-Laird summary risk ratios (RR) and 95% confidence intervals (CIs) were constructed. Results: Sixteen studies with 7611 patients were included. Myocardial infarction was 3.1% with GPI versus 4.4% with control (RR = 0.74; 95% CI, 0.59-0.94, P = 0.014); revascularization, 1.7% versus 2.7% (RR = 0.64; 95% CI, 0.46-0.89, P = 0.008); major bleeding, 2.5% versus 2.1% (RR = 1.21; 95% CI, 0.89-1.63, P = 0.22); minor bleeding, 5.5% versus 4.1% (RR = 1.37; 95% CI, 1.06-1.78, P = 0.016); and mortality, 2.2% versus 2.9% (RR = 0.79; 95% CI, 0.59-1.06, P = 0.12), respectively. Conclusions: Among ACS patients treated with stents and thienopyridines, GPIs were associated with reduced myocardial infarction and revascularization. Minor, but not major bleeding was increased with GPIs. Mortality was similar between the groups.

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Section: Safetymentioning

confidence: 99%

Section: Safetymentioning

confidence: 99%

Efficacy and Safety of Unfractionated Heparin Plus Glycoprotein IIb/IIIa Inhibitors During Revascularization for an Acute Coronary Syndrome: A Meta‐Analysis of Randomized Trials Performed With Stents and Thienopyridines

Winchester

Brearley

Wen

et al. 2011

Clinical Cardiology

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“…9,10 The study results of Van Werkum et al show striking similarities with a previous study which used the same platelet function test. 11 Again only 46% platelet aggregation inhibition was found in the abciximab group and 86% platelet aggregation inhibition in the high-dose tirofiban group. The explanation for this 'drug resistance' might be related to the dose of the drug or the underlying disease.…”

mentioning

confidence: 91%

Does glycoprotein IIB/IIIA resistance exist?

Smit¹,

Hof²

2007

NHJL

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“…A conventional dose of tirofiban showed suboptimal periprocedural platelet inhibition in patients with ST-segment elevation myocardial infarction (STEMI). 3 Several recent clinical studies demonstrated that the use of high-dose bolus tirofiban is safe and improves angiographic and clinical outcomes in patients undergoing high risk PCI. 4 The timing of administration of GP IIb/IIIa inhibitors is also an issue.…”

mentioning

confidence: 99%

Upstream High‐Dose Tirofiban Does Not Reduce Myocardial Infarct Size in Patients Undergoing Primary Percutaneous Coronary Intervention: A Magnetic Resonance Imaging Pilot Study

Song

Hahn

Gwon

et al. 2009

Clinical Cardiology

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Background: Primary percutaneous coronary intervention (PCI) is more effective than fibrinolytic therapy for ST-segment elevation myocardial infarction (STEMI), but initial treatment delay to intervention is the main limitation of this strategy. Hypothesis: Upstream use of high-dose tirofiban could reduce myocardial infarct size, using analysis of contrast-enhanced magnetic resonance imaging (CE-MRI). Methods: Patients with STEMI within 12 hours after symptom onset were randomized to a facilitated PCI group (n = 19) or to a primary PCI group (n = 20). The primary endpoint was myocardial infarct size evaluated by the volume of delayed hyperenhancement on CE-MRI at 1 month after index procedure. Results: The baseline clinical characteristics were not significantly different between the 2 groups. Although the incidence of pre-PCI thrombolysis in myocardial infarction (TIMI) flow grade 2 to 3 was significantly higher in the facilitated PCI group than in the primary PCI group (47.4% vs 15.0%, P = 0.03), the achievement of myocardial blush grade 2 to 3 or ST-segment resolution at 30 minutes after procedure was not significantly different between the facilitated PCI and the primary PCI group (36.8% vs 40%, P = .84 and 31.6% vs 20%, P = 0.41, respectively). Infarct size on CE-MRI was similar in the facilitated PCI group and the conventional primary PCI group (22.1% ± 11.7% vs 25.2% ± 13.2%, P = 0.44). At 6 months, the left ventricular ejection fraction (LVEF) on echocardiography was 52.6% ± 10.4% in the facilitated PCI group and 50.9% ± 9.8% in the primary PCI group (P = 0.68). Conclusion: Despite the improvement of initial TIMI flow grade, the upstream use of high-dose tirofiban did not reduce myocardial infarct size measured by CE-MRI.

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Achieved platelet aggregation inhibition after different antiplatelet regimens during percutaneous coronary intervention for ST-segment elevation myocardial infarction

Cited by 95 publications

References 21 publications

Efficacy and Safety of Unfractionated Heparin Plus Glycoprotein IIb/IIIa Inhibitors During Revascularization for an Acute Coronary Syndrome: A Meta‐Analysis of Randomized Trials Performed With Stents and Thienopyridines

Efficacy and Safety of Unfractionated Heparin Plus Glycoprotein IIb/IIIa Inhibitors During Revascularization for an Acute Coronary Syndrome: A Meta‐Analysis of Randomized Trials Performed With Stents and Thienopyridines

Does glycoprotein IIB/IIIA resistance exist?

Upstream High‐Dose Tirofiban Does Not Reduce Myocardial Infarct Size in Patients Undergoing Primary Percutaneous Coronary Intervention: A Magnetic Resonance Imaging Pilot Study

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