Comparison of abciximab with “high-dose” tirofiban in patients undergoing percutaneous coronary intervention

Gunasekara, A.P.; Walters, D.; Aroney, Con

doi:10.1016/j.ijcard.2005.05.045

Cited by 21 publications

(19 citation statements)

References 19 publications

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“…Compared with abciximab, its advantages as an adjunct therapy for PCI are lower cost and no overt bleeding complications. 9 Results from studies of the efficacy of adjunctive tirofiban in patients undergoing PCI have been inconsistent. [10][11][12] Some have shown beneficial angiographic and clinical outcomes, 13,11 whereas others show either no benefit 14 or modest initial clinical improvements, unsustained at 30-day follow-up.…”

Section: Introductionmentioning

confidence: 99%

“…Also, in the study done byShyh-Ming et al (2006),30 the high bolus dose tirofiban regimen was superior to the conventional dosing regimen in reducing the MACE at one month and one year, but this was statistically non-significant. In the study done byGunasekara et al (2006),9 the high bolus dose tirofiban was as effective as abciximab in reducing the MACE. The results of Gunasekara study were confirmed in the MULTISTRATEGY trial34 and in the FATA study 35.…”

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confidence: 95%

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Impact of upstream high bolus dose tirofiban on left ventricular systolic function in patients with acute anterior myocardial infarction treated by primary coronary intervention

Galal

Essmat

2014

The Egyptian Heart Journal

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Background: Glycoprotein IIb/IIIa inhibitor therapy during primary percutaneous coronary intervention (PCI) decreases the incidence of major adverse cardiac events. Aim: To study the impact of high bolus dose tirofiban on left ventricular ejection fraction in patients with acute anterior ST segment elevation MI treated with primary PCI. Patients and methods: Forty patients presenting to Ain Shams University, and specialized hospitals with the diagnosis of acute anterior STEMI were treated with primary PCI. Twenty patients were given conventional intravenous bolus dose tirofiban (10 lg/kg) upstream prior to primary angioplasty and twenty patients were given intravenous high bolus dose tirofiban (25 lg/kg) upstream prior to PCI. In-hospital follow up was done including echocardiography, and serial cardiac enzymes in addition to clinical follow up for MACE and bleeding complications. Results: Successful primary angioplasty was attained in all patients. The LV systolic function was significantly better in the high bolus dose group in comparison to the conventional bolus dose groups (48% vs 41%, P < 0.01). The incidence of recurrent ischemia was statistically nonsignificant between the two groups (5% vs 25%, P > 0.05). Both regimens were safe and the bleeding complications were minimal and did not differ between the study groups. Conclusion: In patients presenting with acute anterior STEMI and treated with primary PCI, the high bolus dose tirofiban given intravenously upstream prior to PCI seems to be a safe and effective regimen to achieve a better left ventricular ejection fraction in comparison to the conventional bolus dose regimen, without increasing the risk of bleeding.

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Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 95%

Impact of upstream high bolus dose tirofiban on left ventricular systolic function in patients with acute anterior myocardial infarction treated by primary coronary intervention

Galal

Essmat

2014

The Egyptian Heart Journal

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“…Tirofiban is usually not indicated for administration during PCI as the results of the standard dose studied were considered unsatisfactory [10]. Limited published data are available on this high-dose regimen [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

High‐dose tirofiban with enoxaparin and inflammatory markers in high‐risk percutaneous intervention

Walters¹,

Ray²,

Wood³

et al. 2010

Eur J Clin Investigation

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Aim The study assessed the benefit of high bolus dose tirofiban (HD-tirofiban) with enoxaparin compared with HD-tirofiban with unfractionated heparin (UFH). The study examined markers of platelet activation, thrombin generation and inflammation. Materials and methodsThe study is a prospective single centre open-label trial of patients with high-risk acute coronary syndrome treated with percutaneous intervention (PCI) who were randomized to anticoagulation with UFH or enoxaparin with HD-tirofiban (25 lg kg )1 bolus). This study measured a panel of platelet activation markers, inflammatory biomarkers and thrombus generation between the two groups.Result Sixty patients undergoing high-risk PCI were enroled in the study. Platelet inhibition as assessed by whole blood aggregometry following HD-tirofiban infusion was similar in both the UFH and enoxaparin groups. CD40 ligand expression on platelets was significantly reduced following PCI with HD-tirofiban and either UFH or enoxaparin. Following PCI, there were significant reductions measured in other markers of platelet activation including PAC-1, P selectin, factor V ⁄ Va, platelet-monocyte aggregates and monocyte expression of Mac-1 as determined by analysis of venous blood samples using flow cytometry. Prothrombin fragment 1+2, D-dimer, von Willebrand factor and high sensitive C-reactive protein levels were significantly less post PCI in the enoxaparin group compared with those patients receiving UFH. ConclusionThe combination of HD tirofiban with enoxaparin resulted in an attenuated inflammatory response when compared with that of the combination of HD tirofiban with UFH.

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“…1 However, the efficacy of adjunctive administration of tirofiban is controversial in patients undergoing primary percutaneous coronary intervention (PCI). 2 These inconsistent results may result partly from different dosage and timing of administration.…”

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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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Comparison of abciximab with “high-dose” tirofiban in patients undergoing percutaneous coronary intervention

Cited by 21 publications

References 19 publications

Impact of upstream high bolus dose tirofiban on left ventricular systolic function in patients with acute anterior myocardial infarction treated by primary coronary intervention

Impact of upstream high bolus dose tirofiban on left ventricular systolic function in patients with acute anterior myocardial infarction treated by primary coronary intervention

High‐dose tirofiban with enoxaparin and inflammatory markers in high‐risk percutaneous intervention

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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