Randomized, double-blind, placebo-controlled dose-ranging study of tirofiban (MK-383) platelet IIb/IIIa blockade in high risk patients undergoing coronary angioplasty

Kereiakes, J.; Kleiman, Neal S.; Ambrose, John A.; Cohen, Marc; Rodriguez, Samuel; Palabrica, Theresa M.; Herrmann, Howard C.; Sutton, Joseph M.; Weaver, W. Douglas; McKee, Donna B.; Fitzpatrick, Virginia; Sax, Frederic L.

doi:10.1016/0735-1097(95)00500-5

Cited by 213 publications

(76 citation statements)

References 22 publications

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“…Tirofiban dosing has been on the basis of inhibiting PA in response to a weak agonist (5 mol/L ADP), whereas current eptifibatide and abciximab regimens have been dosed to inhibit PA in response to more potent agonists (20 mol/L ADP and thrombin). [7][8][9][10] The use of citrated blood in determining tirofiban dosing may have also resulted in under-dosing relative to eptifibatide and abciximab, as our results and others 18 suggest that the calcium-chelating effects of citrate exaggerate ex vivo platelet inhibition with small molecule, low-affinity GP IIb/IIIa antagonists (eptifibatide and tirofiban). Unlike tirofiban, current eptifibatide regimens have already accounted for this phenomenon.…”

Section: Discussionmentioning

confidence: 83%

“…For example, tirofiban has been dosed to achieve Ͼ90% inhibition of platelet aggregation (PA) in response to 5 mol/L adenosine diphosphate (ADP) in citrate anticoagulated blood. 7 In contrast, eptifibatide and abciximab have been dosed to inhibit PA in response to stronger agonists, such as 20 mol/L ADP or thrombin receptor agonist peptide. 8 -10 Furthermore, whether the calcium-chelating effect of citrate alters abciximab or tirofiban pharmacodynamics, as has been observed with eptifibatide, 11 remains unclear.…”

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confidence: 99%

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Randomized COMparison of Platelet Inhibition With Abciximab, TiRofiban and Eptifibatide During Percutaneous Coronary Intervention in Acute Coronary Syndromes

et al. 2002

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Background-Theand eptifibatide regimens (Pϭ0.0001). The abciximab regimen, however, showed increasingly varied anti-aggregatory effects during continued infusion for Ն4 hours. Citrate exaggerated ex vivo platelet inhibition after eptifibatide and tirofiban, but had the opposite effect on abciximab. Of all regimens evaluated, the eptifibatide regimen inhibited PA most consistently throughout both the early and late periods. Conclusions-Currently recommended drug regimens to inhibit the platelet glycoprotein IIb/IIIa receptor have distinct pharmacodynamic profiles that might affect their relative efficacy in acute coronary syndromes and percutaneous coronary intervention.

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Section: Discussionmentioning

confidence: 83%

mentioning

confidence: 99%

Randomized COMparison of Platelet Inhibition With Abciximab, TiRofiban and Eptifibatide During Percutaneous Coronary Intervention in Acute Coronary Syndromes

et al. 2002

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“…[11][12][13] Additionally, several other selective GPIIb/IIIa antagonists, including eptifibatide (Integrilin, Cor Therapeutics), tirofiban, and lamifiban, are in advanced stages of clinical development and aimed primarily for intravenous use in the treatment and prevention of acute ischemic heart diseases. [13][14][15] Current intravenously administered smallmolecule GPIIb/IIIa antagonists, such as Integrilin or tirofiban, in clinical trials have a faster rate of dissociation from human platelets, reflecting their short duration of antiplatelet effects compared with that of abciximab. 3,16,17 Sustaining antiplatelet efficacy levels with intravenous GPIIb/IIIa antagonists can be achieved with intravenous bolus and infusion regimens.…”

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confidence: 99%

Comparative Antiplatelet Efficacy of a Novel, Nonpeptide GPIIb/IIIa Antagonist (XV454) and Abciximab (c7E3) in Flow Models of Thrombosis

Abulencia

Tien

McCarty

et al. 2001

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Abstract-Glycoprotein (GP) IIb/IIIa is pivotal in homotypic platelet aggregation and may also be involved in the heterotypic adhesion of leukocytes and tumor cells to platelets. This study was primarily undertaken to compare the antiplatelet efficacy of a novel, nonpeptide GPIIb/IIIa antagonist, XV454, to that of abciximab in 2 flow models of platelet thrombus formation: (1) direct shear-induced platelet aggregation imposed by a cone-and-plate rheometer and (2) platelet adhesion onto von Willebrand factor (vWF)/collagen I followed by aggregation in a perfusion system. XV454 inhibited platelet aggregation in a concentration-dependent manner in both experimental models. Maximal inhibition of aggregation was achieved by XV454 at Ϸ70% receptor occupancy, which is lower than the Ն85% previously reported for abciximab. At similar levels of receptor blockade (Ϸ45%), XV454 appeared to be relatively more effective than abciximab in suppressing platelet aggregation. Neither XV454 nor abciximab inhibited platelet adhesion to collagen. Pretreatment of surface-adherent platelets with either XV454 or abciximab inhibited the attachment of monocytic THP-1 cells under flow. In contrast, the rapidly reversible GPIIb/IIIa inhibitor orbofiban failed to suppress these heterotypic interactions.

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“…9 In patient with ACS, PCI via TFA was associated with increase incidence of access site complication are common. [10][11][12] These complications are an important cause of increased patient morbidity, longer hospital stay and higher hospital cost. 13 The superficial location of RA allows easy homeostasis with less bleeding complication.…”

Section: : Percentage Of Distribution Of Types Of Stent Usedmentioning

confidence: 99%

Tran-Radial Percutaneous Coronary Intervention (PCI) is Safe and Alternative to Conventional Trans-Femoral Approach: Our Experiences at Apollo Hospitals Dhaka

et al. 2012

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Background: Aim of the study was to assess the safety of the trans-radial Percutaneous coronary intervention (PCI) than conventional Trans-femoral approach by using either Bare-metal stents (BMS) and or Drug Eluting Stent (DES) like Sirolimus-eluting or Paclitaxel-eluting stent. Also to see its safety in regards of procedural time, quick mobilization, less complication and less radiation exposure.Methods: Total 117 patients were randomized from a total of 538 patients who had PCI at our center in the quantifying period. Total 130 stent deployed in 117 patients. Among the patients, Male: 100 and Female:17. Mean age were for Male: 55yrs, for Female: 57yrs. Associated Coronary artery disease (CAD) risk factors were Dyslipidemia, High Blood pressure, Diabetes Mellitus, Positive FH for CAD and Smoking (all male). Results: Our study shows 21.7% had trans-radial PCI. Among the study group; 72 (61.5%) were Dyslipidemic, 75 (64.1%) were hypertensive: 47(40.2%) patients were Diabetic, FH 29 (24.8%) and 33(33%) were all male smoker. Female patients were more obese (BMI M 27: F 29) and developed CAD in advance age. Common stented territory were LAD 51 (43.6%) followed by RCA 41 (35%) and LCX 27(23%). Average length and diameter of stented vessel were almost same in all territory. Territory wise multiple or overlapping stenting was done in LAD 3 (6 stents), RCA 1(2stents), LCX 4 (10 stents). Stent used: BMS 37 (28.5%), Sirolimus 41(31.5%), Paclitaxel 27 (21%), Everolimus 22 (16.9%), Biolimus 2 (1.5%) and Zotarolimus 1(0.75%). Less Procedural time, reduced radiation exposure, no procedural complication and overall better patient comfort were observed.Conclusion: Our study has revealed that trans-radial PCI is safe with reduced radiation exposure, quick mobilization of patient and no procedural complication in all the case, indicates it can be done routinely as an alternative to conventional Trans-femoral approach. DOI: http://dx.doi.org/10.3329/cardio.v5i1.12274 Cardiovasc. j. 2012; 5(1): 57-61

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Randomized, double-blind, placebo-controlled dose-ranging study of tirofiban (MK-383) platelet IIb/IIIa blockade in high risk patients undergoing coronary angioplasty

Abstract: This study establishes a rational and generally well tolerated dosing regimen for administration of tirofiban as adjunctive therapy in high risk angioplasty patients. The impact of tirofiban on adverse clinical outcomes after angioplasty awaits definition by a larger clinical trial.

Cited by 213 publications

References 22 publications

Randomized COMparison of Platelet Inhibition With Abciximab, TiRofiban and Eptifibatide During Percutaneous Coronary Intervention in Acute Coronary Syndromes

Randomized COMparison of Platelet Inhibition With Abciximab, TiRofiban and Eptifibatide During Percutaneous Coronary Intervention in Acute Coronary Syndromes

Comparative Antiplatelet Efficacy of a Novel, Nonpeptide GPIIb/IIIa Antagonist (XV454) and Abciximab (c7E3) in Flow Models of Thrombosis

Tran-Radial Percutaneous Coronary Intervention (PCI) is Safe and Alternative to Conventional Trans-Femoral Approach: Our Experiences at Apollo Hospitals Dhaka

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