Intracoronary Administration of Abciximab in ST-Elevation Myocardial Infarction

Gibson, C. Michael; Zorkun, Cafer; Kunadian, Vijayalakshmi

doi:10.1161/circulationaha.108.780718

Cited by 12 publications

(4 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recently, a number of factors have narrowed the indications for these agents in treating cardiovascular disease, including the availability of clopidogrel, a thienopyridine related to ticlopidine that has a better toxicity profile and can achieve rapid inhibition of the P2Y 12 receptor with a loading dose (reviewed in in Savi and Herbert 205 and Plosker and Lyseng-Williamson 220 ), and bivalirudin, a direct thrombin inhibitor that acts as both an anticoagulant and antiplatelet agent. 221 Remaining questions include whether the ␣IIb␤3 antagonists will prove uniquely beneficial when given very early after the onset of symptoms, 222,223 when given by the intracoronary route 224,225 (reviewed in Gibson et al 226 ), or when used in combination with a thrombus aspiration device 227 or reduced-dose thrombolytic agents when PCI is not immediately available. 223, 228 The use of ␣IIb␤3 antagonists to treat acute stroke appeared promising in case reports and early phase studies, but a phase 3 study with abciximab failed to show a benefit; whether modifications in patient selection or dosing would improve the results remains an area of investigation.…”

Section: Org Frommentioning

confidence: 99%

The GPIIb/IIIa (integrin αIIbβ3) odyssey: a technology-driven saga of a receptor with twists, turns, and even a bend

Coller

Shattil

2008

Blood

312

342

View full text Add to dashboard Cite

Starting 90 years ago with a clinical description by Glanzmann of a bleeding disorder associated with a defect in platelet function, technologic advances helped investigators identify the defect as a mutation(s) in the integrin family receptor, ␣IIb␤3, which has the capacity to bind fibrinogen (and other ligands) and support platelet-platelet interactions (aggregation). The receptor's activation state was found to be under exquisite control, with activators, inhibitors, and elaborate inside-out signaling mechanisms controlling its conformation. Structural biology has produced high-resolution images defining the ligand binding site at the atomic level. Research on ␣IIb␤3 has been bidirectional, with basic insights resulting in improved Glanzmann thrombasthenia carrier detection and prenatal diagnosis, assays to identify single nucleotide polymorphisms responsible for alloimmune neonatal thrombocytopenia, and the development of ␣IIb␤3 antagonists, the first rationally designed antiplatelet agents, to prevent and treat thrombotic cardiovascular disease. The future looks equally bright, with the potential for improved drugs and the application of gene therapy and stem cell biology to address the genetic abnormalities. The ␣IIb␤3 saga serves as a paradigm of rigorous science growing out of careful clinical observations of a rare disorder yielding both important new scientific information and improved diagnosis, therapy, and prevention of other disorders. (Blood. 2008;112: 3011-3025) Introduction"Thus blood, for all its raw physicality, its heat, color and smell, remains first and foremost a powerfully symbolic substancecapable of representing the most primeval forces of life, and of death." 1 "… for the blood is life …" Deuteronomy 12:23To celebrate the 50th anniversary of Blood, we offer an historical account of research on our favorite receptor on the platelet surface, GPIIb/IIIa, or integrin ␣IIb␤3. This receptor plays an important role in hemostasis and thrombosis, and in accord with the quotations above, both processes have profound effects on life and health. The origin of the English word blood is uncertain. It may derive from a postulated Indo-European root bhel, "bloom" or "sprout," and it has been speculated that "ancient people looked upon the effusion from incised skin as a sort of blooming," 2 an image well known to practitioners of the bleeding time.The dominant theme in this review is how improved understanding of the structure and function of ␣IIb␤3 has led to opportunities to translate that knowledge into biomedical advances, including the development of ␣IIb␤3 antagonists, the first class of rationally designed antiplatelet agents. The subtheme is how advances in scientific technology deriving from discoveries in other fields have been crucial to improving our understanding of ␣IIb␤3. Figure 1 is a timeline depicting, by category, approximately when different technologies were introduced into the investigation of blood platelets and/or ␣IIb␤3. Thus, as with a musical fugue, we will try to tell 2 sto...

show abstract

Section: Org Frommentioning

confidence: 99%

The GPIIb/IIIa (integrin αIIbβ3) odyssey: a technology-driven saga of a receptor with twists, turns, and even a bend

Coller

Shattil

2008

Blood

312

342

View full text Add to dashboard Cite

show abstract

“…It is a medical condition where air enters the pericardial cavity and a well-recognized clinical and radiologic entity. It can be congenital, or introduced by a wound (25) .…”

Section: Pneumopericardiummentioning

confidence: 99%

Role of CT and MRI in Diagnosis of Pericardial Diseases

Mahmoud

Abdurrahman

Khalek

2018

Egyptian Journal of Hospital Medicine

View full text Add to dashboard Cite

Background: pericardial diseases are important causes of morbidity and mortality in cardiovascular diseases. CT and MRI are more than adjuncts to echocardiography in pericardial diseases assessment, as they provide an excellent pericardial anatomy delineation and precise pericardial lesions evaluation including; effusion, constrictive pericarditis, thickening, masses and congenital anomalies. Ideal management needs the proper imaging modality choosing ability. Aim of the Study: this study aimed to evaluate the role of CT and MRI versus echocardiography in the diagnosis of pericardial diseases and to show the limitations of each modality. Conclusion: tissue characterization with CMR is superior to cardiac CT and echocardiography. CMR can differentiate tumor from thrombus and is often helpful to assess the perfusion of a pericardial mass with the use of gadolinium contrast. The final diagnosis depends on typical pathologic features.

show abstract

“…The increased concentration of Gp IIb/IIIa inhibitors like Abciximab, Eptifibatide, Tirofiban are shown to improve the outcomes of PCI safely and efficaciously in terms of reduction in infarct size, peri-procedural MI and improved TIMI flow [7].…”

Section: Intracoronary Gp Iib/iiia Inhibitorsmentioning

confidence: 99%

Acute ST-Segment Elevation Myocardial Infarction: Combined Intracoronary Low Dose Eptifibatide and Thrombus Aspiration

Mahmoud¹

2014

WJCD

View full text Add to dashboard Cite

Aim of the work: To evaluate the efficacy and safety of bolus only intra coronary platelet glycoprotein GP IIb/IIIa receptor antagonists combined with thrombus-aspiration during percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI). Patient and Methods: 25 consecutive STEMI patients treated by primary PCI including thrombus aspiration were prospectively enrolled, from a total of 180 PCIs performed at our institution between January 2013 and January 2014. All patients received aspirin (250 mg i.v.) and clopidogrel (600 or 300 mg if already on clopidogrel) plus standard heparin. Glycoprotein IIb/IIIa antagonists were administered at physicians' discretion before thrombus aspiration. Eptifibatide was used as a slandered Glycoprotein IIb/IIIa antagonists as a dose of the 180-μg/kg eptifibatide bolus only. The bolus was administered for 2 minutes via the thrombus aspiration catheter (STEMI cath of minvasys) just before thrombus aspiration. Twelve-lead ECGs were recorded at baseline and 60 min (45 -75 min) after completion of PCI. The primary endpoint was the TIMI 3 patency of the infarctrelated coronary artery before PCI. Secondary endpoints were TIMI patency following PCI, ST resolution 60 min after PCI, all-cause death, reinfarction, urgent revascularization, stroke (haemorrhagic, non-haemorrhagic), and severe bleeding complications. Results: The angiography was performed in all 25 patients. The incidence of a TIMI flow grade 3 of the infarct-related coronary artery before PCI was 16% while TIMI grade 2 and I was 24% and 36% respectively. The incidence of a TIMI flow grade 0 (no reflow) of the infarct-related coronary artery before PCI was 24%. Visible thrombus in 52% of patients and 40% of patients have more than one critically disease vessel. Primary PCI was performed in 25 patients. Eptifibatide intracoronary was given through thrombus aspiration catheter before thrombus aspiration. Drug eluting stents were implanted in 60% of patients. Only two patients with acute stent thrombosis did not receive any stents at PCI. One patient died 24 h after the procedure due to severe heart failure and cardiogenic shock. No reinfarction was noted within 30 days after the procedure. Generally heart failure improved significantly after the procedure and at the end of 30 day post operative. Only 3 patients had persistent heart S. E. Mahmoud 571 failure class III (12%). 84% of patients had TIMI flow III at the end of procedure with over all significant improvement. Significant TIMI flow improvement after procedure was noticed with P value, 001. Also the results showed significant shows of ST segment resolution after procedure. Conclusions: For patients with STEMI undergoing primary PCI, a routine combination of intracoronary administration of Eptifibatide before transcatheter thrombus aspiration is a safe procedure with low risk of hemorrhage and increases myocardial reperfusion, which ultimately improves outcomes. This therapeutic modality may be recommended for further improving ...

show abstract

Intracoronary Administration of Abciximab in ST-Elevation Myocardial Infarction

Cited by 12 publications

References 19 publications

The GPIIb/IIIa (integrin αIIbβ3) odyssey: a technology-driven saga of a receptor with twists, turns, and even a bend

The GPIIb/IIIa (integrin αIIbβ3) odyssey: a technology-driven saga of a receptor with twists, turns, and even a bend

Role of CT and MRI in Diagnosis of Pericardial Diseases

Acute ST-Segment Elevation Myocardial Infarction: Combined Intracoronary Low Dose Eptifibatide and Thrombus Aspiration

Contact Info

Product

Resources

About