Shanmugam Ganesh
Department of Cardiac Surgery, Royal Hospital for Sick Children, Dalnair Street, Glasgow G3 8SJ, UK.
Eur J Cardiothorac Surg. 2005 Oct;28(4):546-50. doi: 10.1016/j.ejcts.2005.07.008.
The final common pathway of platelet aggregation leading to coronary thrombosis involves cross-linking of platelet receptor glycoprotein IIb-IIIa by primarily fibrinogen. Glycoprotein IIb-IIIa antagonists are being increasingly used as adjunctive therapy during percutaneous coronary intevention, and have shown to reduce the risk of death and myocardial infarction. However, a proportion of these patients continue to remain ischemic and present for emergency coronary grafting. The profound platelet inhibition in these patients enhances the already heightened risk of post-operative bleeding. With the recent approval of tirofiban for patients with acute coronary syndromes, the number of patients receiving tirofiban who subsequently undergo coronary artery bypass grafting is expected to increase substantially. Little clinical data exist, on patients who require immediate coronary artery grafting after receiving tirofiban. This article reviews the evidence for bleeding following tirofiban, discusses the relevant mechanism of action and pharmacodynamics, and analyses the strategies available in patients who need emergency coronary artery grafting after tirofiban.
导致冠状动脉血栓形成的血小板聚集的最终共同途径主要涉及纤维蛋白原对血小板受体糖蛋白IIb-IIIa的交联。糖蛋白IIb-IIIa拮抗剂在经皮冠状动脉介入治疗期间越来越多地用作辅助治疗，并已显示可降低死亡和心肌梗死风险。然而，这些患者中有一部分仍持续存在缺血情况，并需要进行急诊冠状动脉搭桥术。这些患者中深度血小板抑制会增加本已较高的术后出血风险。随着替罗非班最近被批准用于急性冠状动脉综合征患者，接受替罗非班治疗后随后接受冠状动脉搭桥术的患者数量预计将大幅增加。对于接受替罗非班后需要立即进行冠状动脉搭桥术的患者，几乎没有临床数据。本文综述了替罗非班治疗后出血的证据，讨论了相关作用机制和药效学，并分析了替罗非班治疗后需要急诊冠状动脉搭桥术的患者可用的策略。
