Suleiman Mahmoud, Gruberg Luis, Hammerman Haim, Aronson Doron, Halabi Majdi, Goldberg Alexander, Grenadier Ehud, Boulus Monther, Markiewicz Walter, Beyar Rafael
Division of Invasive Cardiology, Department of Cardiology, Rambam Medical Center, Haifa-31096, Israel.
J Invasive Cardiol. 2003 Jun;15(6):319-23.
Platelet glycoprotein IIb/IIIa inhibitors have significantly reduced the incidence of 30-day ischemic events during percutaneous coronary interventions (PCI). However, each of the three currently available agents has different pharmacological characteristics, safety, efficacy and costs. There has not been a direct comparison between eptifibatide and abciximab in the rates of major adverse cardiac events, major complications and thrombocytopenia.
A total of 642 consecutive patients underwent PCI at our institution between January 2000 and December 2001 and were treated with either eptifibatide (n = 342) or abciximab (n = 300) during the procedure. The selection of the IIb/IIIa inhibitor was arbitrary and left to the discretion of the operator. Complete blood counts were performed by routine protocol on all patients 2 and 4 hours after initiation of the drug. We analyzed the in-hospital clinical outcomes and the incidence of thrombocytopenia in this cohort.
Baseline clinical and angiographic characteristics and concomitant drug treatment were similar between the 2 groups, except for a higher incidence of diabetes in the eptifibatide group. The rates of in-hospital death (1.2% eptifibatide group versus 1.0% abciximab group; p = 0.7), stroke (0% for both groups), target vessel revascularization (1.2% eptifibatide group versus 1.0% abciximab group; p = 0.8) and major bleeding complications (1.7% eptifibatide group versus 0.7% abciximab group; p = 0.2) were similar between the 2 groups. Thrombocytopenia was more frequent in the abciximab-treated patients (6%, versus 0% in the eptifibatide group; p < 0.001), including 5 patients who developed profound thrombocytopenia (< 20,000 cells/mm3).
Both agents, eptifibatide and abciximab, proved to have the same rates of in-hospital major adverse cardiac events, bleeding and vascular complications. Abciximab therapy was associated with a significantly higher incidence of thrombocytopenia within 4 hours of drug initiation, which prompted immediate drug discontinuation, but was not associated with increased risk of bleeding, vascular or other complications.
血小板糖蛋白IIb/IIIa抑制剂已显著降低经皮冠状动脉介入治疗（PCI）期间30天缺血事件的发生率。然而，目前可用的三种药物各有不同的药理特性、安全性、疗效和成本。在主要不良心脏事件、主要并发症和血小板减少症发生率方面，依替巴肽和阿昔单抗之间尚未进行直接比较。
2000年1月至2001年12月期间，共有642例连续患者在我院接受了PCI治疗，术中分别接受依替巴肽治疗（n = 342）或阿昔单抗治疗（n = 300）。IIb/IIIa抑制剂的选择是任意的，由操作者自行决定。所有患者在开始用药后2小时和4小时按照常规方案进行全血细胞计数。我们分析了该队列患者的院内临床结局和血小板减少症的发生率。
两组患者的基线临床和血管造影特征以及伴随药物治疗相似，但依替巴肽组糖尿病发生率较高。两组患者的院内死亡率（依替巴肽组为1.2%，阿昔单抗组为1.0%；p = 0.7）、中风发生率（两组均为0%）、靶血管血运重建率（依替巴肽组为1.2%，阿昔单抗组为1.0%；p = 0.8）和主要出血并发症发生率（依替巴肽组为1.7%，阿昔单抗组为0.7%；p = 0.2）相似。接受阿昔单抗治疗的患者血小板减少症更为常见（6%，而依替巴肽组为0%；p < 0.001），其中包括5例发生严重血小板减少症（< 20,000个细胞/mm3）的患者。
依替巴肽和阿昔单抗这两种药物在院内主要不良心脏事件、出血和血管并发症发生率方面相同。阿昔单抗治疗在用药后4小时内血小板减少症发生率显著更高，这促使立即停药，但与出血、血管或其他并发症风险增加无关。
