替罗非班高剂量与阿昔单抗抑制 ST 段抬高型心肌梗死患者直接经皮冠状动脉介入治疗后血小板功能：一项随机试验。

Inhibition of platelet function by abciximab or high-dose tirofiban in patients with STEMI undergoing primary PCI: a randomised trial.

机构信息

Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands.

出版信息

Neth Heart J. 2007;15(11):375-81. doi: 10.1007/BF03086018.

DOI:10.1007/BF03086018

PMID:18176639

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2082085/

Abstract

BACKGROUND

In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI, few data exist on the magnitude of platelet activation, aggregation and dosing of glycoprotein (GP) IIb/IIIa receptor inhibitors.

METHODS

Sixty STEMI patients were randomised to abciximab, to high-dose tirofiban or to no additional GP IIb/IIIa inhibitor treatment. Platelet activation (P-selectin expression) was measured using flow cytometry and the level of inhibition of platelet aggregation was assessed using the Plateletworks assay. Additionally, the PFA-100 with the collagen/adenosine-diphosphate cartridge (CADP) was used to compare the levels of platelet inhibition. All measurements were performed at baseline (T(0)), immediately after (T(1)), 30 minutes (T(2)), 60 minutes (T(3)) and 120 minutes (T(4)) after primary PCI.

RESULTS

The level of platelet activation in both GP IIb/IIIa receptor inhibitor treated groups was significantly lower compared with the control group at all time points after primary PCI (p=0.04). Also the administration of the currently recommended dose of abciximab resulted in significantly lower levels of inhibition of aggregation compared with high-dose tirofiban (p<0.0001). In addition, the CADP closure times were significantly prolonged in both GP IIb/IIIa inhibitor treated groups compared with the control group at time points T(1) (p=0.006) and T(4) (p<0.0001).

CONCLUSION

The administration of high-dose tirofiban resulted in a significantly higher inhibition of platelet aggregation compared with the currently recommended dose of abciximab. Large clinical trials are needed to assess whether this laboratory superiority of high-dose tirofiban translates into higher clinical efficacy. (Neth Heart J 2007;15:375-81.).

摘要

背景

在接受直接经皮冠状动脉介入治疗（PCI）的 ST 段抬高型心肌梗死（STEMI）患者中，关于血小板激活、聚集和糖蛋白（GP）IIb/IIIa 受体抑制剂剂量的数据很少。

方法

60 例 STEMI 患者被随机分为阿昔单抗组、高剂量替罗非班组或不接受额外 GP IIb/IIIa 抑制剂治疗组。采用流式细胞术测量血小板激活（P-选择素表达），使用血小板聚集试验（Plateletworks assay）评估血小板聚集抑制水平。此外，使用 PFA-100 联合胶原/二磷酸腺苷（CADP）检测血小板抑制水平。所有测量均在直接 PCI 前（T(0)）、即刻（T(1)）、30 分钟（T(2)）、60 分钟（T(3)）和 120 分钟（T(4)）进行。

结果

在直接 PCI 后所有时间点，与对照组相比，两种 GP IIb/IIIa 受体抑制剂治疗组的血小板激活水平均显著降低（p=0.04）。此外，与高剂量替罗非班相比，阿昔单抗的目前推荐剂量的给药导致血小板聚集抑制水平显著降低（p<0.0001）。此外，与对照组相比，在 T(1)（p=0.006）和 T(4)（p<0.0001）时，两种 GP IIb/IIIa 抑制剂治疗组的 CADP 闭合时间均显著延长。