Marmur Jonathan D, Poludasu Shyam, Agarwal Ajay, Vladutiu Pompeiu, Feit Alan, Lapin Reuven, Cavusoglu Erdal
State University of New York, SUNY Downstate Medical Center, Brooklyn, New York, USA.
J Invasive Cardiol. 2006 Nov;18(11):521-6.
Platelet glycoprotein IIb-IIIa inhibitors (GPI) are traditionally administered as a bolus followed by an infusion. In the current era of routine stenting, we hypothesized that a bolus-only GPI strategy can be used during percutaneous coronary intervention (PCI) in order to reduce bleeding complications, while preserving the benefits of inhibition of platelet aggregation at the time of device deployment.
We retrospectively analyzed consecutive patients (n = 1001) who underwent PCI and received an unfractionated heparin (UFH) and bolus-only GPI regimen, from January 2003 to August 2004 in a single institution. All patients received clopidogrel and aspirin prior to PCI. Post-procedure myocardial infarction (MI) was defined using the TIMI definitions, and bleeding complications were defined by the criteria used in REPLACE-2.
The most frequently used GPI was eptifibatide (58.3%), followed by abciximab (37.3%) and tirofiban (4.3%). The composite outcome of in-hospital death (0.1%), MI (4.3%), repeat revascularization (0) and major plus minor bleeding (2.6%) was 7%. These rates are lower than those that have been reported in the UFH group with planned GPI, and the bivalirudin with provisional GPI arms of the REPLACE-2 trial. After adjustment for baseline and procedural risk factors, the abciximab bolus-only group had a higher rate of major bleeding compared to the eptifibatide bolus-only group (adjusted odds ratio 3.5, 95% confidence intervals 1.047 and 11.698; p < 0.05).
A bolus-only GPI strategy appears to maintain the anti-ischemic benefits of GPI, with the added benefit of reduced bleeding complications and the potential for reduced cost and shortened length of hospital stay.
血小板糖蛋白IIb-IIIa抑制剂（GPI）传统上采用静脉推注后持续输注的给药方式。在当前常规支架置入的时代，我们推测在经皮冠状动脉介入治疗（PCI）期间可采用仅静脉推注GPI的策略，以减少出血并发症，同时在器械置入时保留抑制血小板聚集的益处。
我们回顾性分析了2003年1月至2004年8月在单一机构接受PCI并接受普通肝素（UFH）和仅静脉推注GPI方案的连续患者（n = 1001）。所有患者在PCI前均接受氯吡格雷和阿司匹林治疗。术后心肌梗死（MI）采用TIMI定义，出血并发症按照REPLACE-2中使用的标准定义。
最常用的GPI是依替巴肽（58.3%），其次是阿昔单抗（37.3%）和替罗非班（4.3%）。住院死亡（0.1%）、MI（4.3%）、再次血管重建（0）和严重及轻微出血（2.6%）的复合结局为7%。这些发生率低于UFH联合计划使用GPI组以及REPLACE-2试验中比伐卢定联合临时使用GPI组所报告的发生率。在对基线和手术风险因素进行校正后，仅使用阿昔单抗静脉推注组的严重出血发生率高于仅使用依替巴肽静脉推注组（校正比值比3.5，95%置信区间1.047至11.698；p < 0.05）。
仅静脉推注GPI的策略似乎能维持GPI的抗缺血益处，同时具有减少出血并发症的额外益处，并且有可能降低成本和缩短住院时间。
