Rapid Assessment of Platelet Function With a Modified Whole-Blood Aggregometer in Percutaneous Transluminal Coronary Angioplasty Patients Receiving Anti-GP IIb/IIIa Therapy

Mascelli, Mary Ann; Worley, Seth J.; Veriabo, Nicholas J.; Lance, Ellen T.; Mack, Sabina; Schaible, Tom; Weisman, Harlan F.; Jordan, Robert E.

doi:10.1161/01.cir.96.11.3860

Cited by 90 publications

(59 citation statements)

References 22 publications

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confidence: 72%

“…Previous studies of the pharmacokinetics of abciximab 8,20,21 and the data from Mascelli et al 22 support the hypothesis that most patients appear to achieve and sustain the 80% threshold level with the current dose of 0.25 mg /kg bolus and infusions of either 10 g /min or 0.125 g ⅐ kg Ϫ1 ⅐ min Ϫ1 . However, some interindividual variations in receptor blockade have been observed, 20,21 and as seen in Fig 1 of the study by Mascelli et al, 22 mean GP IIb/IIIa receptor blockade was Ϸ80% at 6 and 12 hours after therapy was initiated, so some patients may have been below this level. Moreover, because the theoretical peak whole-blood level of abciximab exceeds the amount of antibody required to fully saturate the GP IIb/IIIa receptors on a normal number of circulating platelets by only approximately twofold, it is predictable that patients with severe thrombocytosis will not achieve as high a degree of receptor blockade as patients with normal platelet counts, and one published case has documented this phenomenon.…”

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confidence: 72%

“…Moreover, because the theoretical peak whole-blood level of abciximab exceeds the amount of antibody required to fully saturate the GP IIb/IIIa receptors on a normal number of circulating platelets by only approximately twofold, it is predictable that patients with severe thrombocytosis will not achieve as high a degree of receptor blockade as patients with normal platelet counts, and one published case has documented this phenomenon. 20 The platelet counts of the patients in the first stage of the study by Mascelli et al 22 were not provided, but the highest count in the second stage was only 337 000 L. Thus, a systematic assessment of the effect of elevated platelet counts on the efficacy of abciximab would be desirable, and dose adjustments in this subgroup have the potential to improve efficacy.…”

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confidence: 99%

“…Moreover, it appears that the calcium chelation caused by citrate anticoagulation may artifactually enhance the inhibition observed with some GP IIb/IIIa antagonists such as eptifibatide (Integrilin). 29 Mascelli et al, 22 recognizing the practical limitations of turbidimetric aggregometry, used whole-blood aggregometry (modified to include automated calibration and readout functions), which relies on impedance measurements and requires only dilution of whole blood. It does, however, require relatively expensive equipment, the need to prepare and pipette reagents, proper care of the electrode, and appropriate quality control procedures.…”

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confidence: 99%

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Monitoring Platelet GP IIb/IIIa Antagonist Therapy

Coller

1998

Circulation

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Platelet GP IIb/IIIa receptor antagonist therapy with abciximab (ReoPro), the Fab fragment of a mouse/ human chimeric version of the murine 7E3 antibody, is currently used to prevent ischemic complications of percutaneous coronary interventions in select cases, and the efficacy and safety of abciximab for other related indications are under study.1-4 A number of low-molecular-weight GP IIb/IIIa antagonists patterned on the arginine-glycine-aspartic acid (RGD) cell recognition sequence have also shown benefit in the prevention and treatment of ischemic thrombotic coronary artery disease and currently are in advanced stages of development and approval.

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confidence: 72%

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confidence: 72%

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confidence: 99%

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confidence: 99%

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Monitoring Platelet GP IIb/IIIa Antagonist Therapy

Coller

1998

Circulation

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“…Platelet transfusion may reverse the effects of abciximab while waiting for its elimination; however, the antiaggregation conferred by tirofiban cannot be reversed by platelet transfusion. (43) Most anticoagulant studies have involved oral anticoagulant therapy, although some of the patients included received heparin. Aggressive reversal of the international normalized ratio (INR) reduces mortality from 37 to 10%.…”

Section: Treatment Of Bleeding In Nste Acsmentioning

confidence: 99%

Sangramento em síndrome coronariana aguda sem supradesnivelamento de segmento ST

Moraes¹,

Chammas²,

Neto³

et al. 2012

Rev. bras. ter. intensiva

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The development of antiplatelet and antithrombotic therapies, in addition to interventionist strategy, has resulted in great improvements in the outcomes of patients with non-ST-segment elevation acute coronary syndrome. Parallel to therapeutic advances, bleeding, which can be induced during management, increases the risk of recurrent ischemia, myocardial infarction and death. The present literature review describes the benefits and bleeding risks of each medication or intervention strategy and suggests guidelines for managing these patients. arteries) scores are prominent. The TIMI score was the first to be developed and is widely used; however, it has low sensitivity, given that hemoglobin needs to be reduced by 5 g/dL for bleeding to be considered severe. The GUSTO score has a higher sensitivity and better correlation with death and reinfarction at 30 days and at 6 months compared to TIMI.(8) The variety of scores (Table 1) has complicated comparisons between studies.With the purpose of standardizing the definitions of bleeding, North American institutions have recently created the Bleeding Academic Research Consortium (BARC).(9) This score stratifies bleeding on a scale from 0 (no bleeding) to 5 (fatal bleeding) and, as a major advantage, provides the ability to assess patients subjected to myocardial revascularization surgery (MRS).(9) Because BARC's definitions of bleeding have been achieved by consensus, it still requires validation, and new studies on ACS are encouraged to use this score together with previous scores so that such validation may be achieved in the near future.(9) For now, comparisons between studies of bleeding outcomes demand caution. BENEFITS AND RISKS OF NSTE ACS TREATMENTKnowledge of the risk-benefit ratio of the various tools used in the treatment of ACS is essential for the individualization of therapy (Table 2).Acetylsalicylic acid (ASA) was one of the first medications assessed for the treatment of NSTE ACS and was established as a proven method after demonstrating a 56% reduction in cardiovascular death.(10) The antiplatelet effect of ASA is irreversible and results from its inhibition of thromboxane A2. In the long run, smaller daily doses of 75 to 100 mg provide the same benefit as do larger doses of 200 mg and reduce the incidence of major bleeding by 1.8%, according to the CURE (Clopidogrel in Unstable angina to prevent Recurrent Events) criteria.(11) The gastrointestinal tract is the most common site of bleeding caused by ASA, and its chronic use increases absolute risk by 0.12% a year.(12) Acetylsalicylic acid increases the risk of intracranial bleeding 1.65-fold for an increase in absolute annual risk of 0.03%.(12) Given the great benefit on mortality provided by ASA in treatment and secondary prevention, the risk of bleeding hardly justifies its nonprescription. Therefore, ASA is contraindicated only in cases of known hypersensitivity, active peptic ulcers, blood dyscrasias or severe liver disease. (13) Clopidogrel, a thienopyridine, is an alternative for patient...

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Use of ICHOR‐platelet works to assess platelet function in patients treated with GP IIb/IIIa inhibitors

Lakkis

George

Thomas

et al. 2001

Cathet Cardio Intervent

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Platelet glycoprotein GP IIb/IIIa inhibitors have been recently approved for use in treating patients with acute coronary syndromes and those undergoing PCI. The purpose of this study was to assess the feasibility of using a new device, the ICHOR platelet works, to detect platelet inhibition in patients undergoing PCI and treated with abciximab or tirofiban. The study was conducted at Baylor College of Medicine, Houston, Texas. Thirty patients undergoing PCI and treated with abciximab (n = 10) or tirofiban (n = 20) are included. Blood samples were obtained before, at 30 min, at 4 hr, and at 12 hr after starting the GP IIb/IIIa inhibitors and 2 hr after discontinuation. Baseline studies revealed > 95% platelet aggregability in all patients after exposure to ADP (20 microM). After starting tirofiban, 82%, 83%, and 82% of platelets were inhibited at 30 min, 4 hr, and 12 hr. Platelet inhibition decreased to 43% 2 hr after discontinuation of tirofiban. Similarly, ICHOR platelet works detected 91%, 92%, and 85% platelet inhibition at 30 min, 4 hr, and 12 hr after starting abciximab, respectively. Platelet inhibition decreased to 73% 2 hr after discontinuation. The ICHOR platelet works is a promising, simple, and rapid bedside method that may have clinical utility in assessing platelet inhibition in patients treated with GP IIb/IIIa inhibitors. Cathet Cardiovasc Intervent 2001;53:346-351.

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Rapid Assessment of Platelet Function With a Modified Whole-Blood Aggregometer in Percutaneous Transluminal Coronary Angioplasty Patients Receiving Anti-GP IIb/IIIa Therapy

Cited by 90 publications

References 22 publications

Monitoring Platelet GP IIb/IIIa Antagonist Therapy

Monitoring Platelet GP IIb/IIIa Antagonist Therapy

Sangramento em síndrome coronariana aguda sem supradesnivelamento de segmento ST

Use of ICHOR‐platelet works to assess platelet function in patients treated with GP IIb/IIIa inhibitors

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