Lev Eli I, Hasdai David, Scapa Erez, Tobar Ana, Assali Abid, Lahav Judith, Battler Alexander, Badimon Juan J, Kornowski Ran
Cardiology Department, Rabin Medical Center, 39 Jabotinski Street, Petah-Tikva 49100, Israel.
J Am Coll Cardiol. 2004 Mar 17;43(6):966-71. doi: 10.1016/j.jacc.2003.09.060.
The goal of this study was to compare the antithrombotic effects of enoxaparin versus unfractionated heparin (UFH) when combined with eptifibatide in acute coronary syndrome (ACS) patients.
An increasing number of high-risk ACS patients are treated with low-molecular-weight heparin and a glycoprotein (GP) IIb/IIIa inhibitor. There is a paucity of data regarding the antithrombotic properties of such a combination as compared with UFH and GP IIb/IIIa inhibitors.
Twenty-six ACS patients scheduled to undergo coronary angiography were treated with subcutaneous enoxaparin (n = 13) or intravenous UFH (n = 13). All patients received eptifibatide just before coronary angiography. Antithrombotic effects were assessed as changes in platelet-thrombus formation using the Badimon ex vivo perfusion chamber. Perfusions were carried out at a high shear rate (HSR) and a low shear rate (LSR). Patients underwent two perfusion studies: at baseline (under enoxaparin or UFH) and 10 min after the eptifibatide bolus. Platelet function was evaluated by ADP-induced platelet aggregation and the rapid platelet function analyzer.
Both therapeutic combinations achieved a marked reduction in platelet aggregation after eptifibatide (83% to 89.7% reduction in the enoxaparin-eptifibatide group and 77.8% to 85.5% reduction in the UFH-eptifibatide group, inter-group differences not significant). Both groups also demonstrated marked reductions in thrombus formation, but the reductions achieved in the enoxaparin-eptifibatide group were significantly higher than those achieved in the UFH-eptifibatide group (HSR: 75.6% reduction vs. 63.9%, respectively, p = 0.01; LSR: 79.7% reduction vs. 66.1%, respectively, p = 0.0001).
The combination of eptifibatide with enoxaparin appears to have a more potent antithrombotic effect than that of eptifibatide and UFH in the doses tested.
本研究的目的是比较依诺肝素与普通肝素（UFH）在急性冠状动脉综合征（ACS）患者中与依替巴肽联合使用时的抗血栓形成作用。
越来越多的高危ACS患者接受低分子量肝素和糖蛋白（GP）IIb/IIIa抑制剂治疗。与UFH和GP IIb/IIIa抑制剂相比，关于这种联合用药的抗血栓形成特性的数据较少。
26例计划进行冠状动脉造影的ACS患者接受皮下依诺肝素（n = 13）或静脉UFH（n = 13）治疗。所有患者在冠状动脉造影前即刻接受依替巴肽治疗。使用Badimon体外灌注室，将抗血栓形成作用评估为血小板血栓形成的变化。灌注在高剪切率（HSR）和低剪切率（LSR）下进行。患者进行了两项灌注研究：基线时（接受依诺肝素或UFH）和依替巴肽推注后10分钟。通过ADP诱导的血小板聚集和快速血小板功能分析仪评估血小板功能。
两种治疗组合在依替巴肽治疗后均使血小板聚集显著降低（依诺肝素 - 依替巴肽组降低83%至89.7%，UFH - 依替巴肽组降低77.8%至85.5%，组间差异不显著）。两组血栓形成也均显著降低，但依诺肝素 - 依替巴肽组的降低幅度显著高于UFH - 依替巴肽组（HSR：分别降低75.6%和63.9%，p = 0.01；LSR：分别降低79.7%和66.1%，p = 0.0001）。
在测试剂量下，依替巴肽与依诺肝素联合使用似乎比依替巴肽与UFH联合使用具有更强的抗血栓形成作用。
