Massberg Steffen, Mueller Iris, Besta Felicitas, Thomas Phillip, Gawaz Meinrad
Deutsches Herzzentrum und 1. Medizinische Klinik und Poliklinik, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Am Heart J. 2003 Nov;146(5):E19. doi: 10.1016/S0002-8703(03)00368-5.
We sought to compare the antiplatelet effects of the glycoprotein IIb-IIIa receptor blockers abciximab or tirofiban, combined with an adjuvant therapy with clopidogrel and aspirin.
Twenty patients undergoing coronary stenting were randomly assigned to receive either abciximab or tirofiban combined with aspirin and clopidogrel. Serial blood samples were taken to assess platelet aggregation, P-selectin expression, thrombin generation, and platelet-induced endothelial cell expression of MCP-1, uPAR, and ICAM-1. Results and conclusions The therapy with aspirin plus clopidogrel attenuated agonist-induced platelet aggregation and P-selectin surface exposure (P <.05 vs aspirin monotherapy). Both tirofiban and abciximab further reduced agonist-induced platelet aggregation (P <.05), and decreased thrombin generation but had no effect on platelet alpha-granule release. None of the antithrombotic strategies significantly affected platelet-induced endothelial cell activation. Since platelet adhesion/degranulation initiates an inflammatory/mitogenic response in the vascular wall, future therapeutic strategies will have to be aimed at the inhibition of platelet release reactions.
我们试图比较糖蛋白IIb-IIIa受体阻滞剂阿昔单抗或替罗非班与氯吡格雷和阿司匹林辅助治疗联合使用时的抗血小板作用。
20例接受冠状动脉支架置入术的患者被随机分配接受阿昔单抗或替罗非班联合阿司匹林和氯吡格雷治疗。采集系列血样以评估血小板聚集、P-选择素表达、凝血酶生成以及血小板诱导的内皮细胞MCP-1、uPAR和ICAM-1表达。结果与结论：阿司匹林加氯吡格雷治疗减弱了激动剂诱导的血小板聚集和P-选择素表面暴露（与单用阿司匹林相比，P<.05）。替罗非班和阿昔单抗均进一步降低了激动剂诱导的血小板聚集（P<.05），并减少了凝血酶生成，但对血小板α-颗粒释放无影响。没有一种抗血栓策略能显著影响血小板诱导的内皮细胞活化。由于血小板黏附/脱颗粒会引发血管壁的炎症/促有丝分裂反应，未来的治疗策略将必须旨在抑制血小板释放反应。
