Holmes Lewis E, Gupta Rohan, Rajendran Saissan, Luu John, French John K, Juergens Craig P
South Western Sydney Clinical School, The University of New South Wales, Sydney, NSW, Australia.
Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia.
Cardiovasc Ther. 2016 Oct;34(5):330-6. doi: 10.1111/1755-5922.12203.
To compare three glycoprotein IIb/IIIa receptor antagonists (GPIs) in terms of platelet inhibition and major adverse cardiac events (MACEs), and assess the rate of bleeding and MACEs between GPIs and coadministered P2Y12 agents.
Eighty-three acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) with planned GPI use were randomized to receive high-dose bolus tirofiban, double-bolus eptifibatide, or abciximab followed by a 12-hour infusion. Glycoprotein IIb/IIIa platelet receptor inhibition was measured at baseline and at 10 minutes, 1 hour, and 24 hours postbolus dose. Major adverse cardiac events and bleeding complications at 30 days were documented. The incidence of MACEs and bleeding in patients receiving ticagrelor or prasugrel were compared to those given clopidogrel.
There were no statistically significant differences in platelet inhibition between GPIs at 10 minutes (P=.085) and 1 hour (P=.337). At 24 hours, abciximab achieved statistically significantly higher median [interquartile range] platelet inhibition (75 [65-88]%) compared to tirofiban (28 [3-56]%; P<.0001) and eptifibatide (44 [31-63]%; P=.007). There were no differences in bleeding or MACEs depending on GPI or P2Y12 inhibitor administered.
Glycoprotein receptor inhibitors achieve similar levels of platelet inhibition at 10 minutes and 1 hour; however, abciximab maintains this benefit 24 hours after bolus dose. We did not witness an increased rate of bleeding in patients given new potent P2Y12 inhibitors and a GPI in the modern era.
比较三种糖蛋白IIb/IIIa受体拮抗剂（GPIs）在血小板抑制和主要不良心脏事件（MACEs）方面的差异，并评估GPIs与联合使用的P2Y12药物之间的出血率和MACEs。
83例计划使用GPI进行经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）患者被随机分为接受高剂量推注替罗非班、双推注依替巴肽或阿昔单抗，随后进行12小时输注。在基线、推注剂量后10分钟、1小时和24小时测量糖蛋白IIb/IIIa血小板受体抑制情况。记录30天时的主要不良心脏事件和出血并发症。比较接受替格瑞洛或普拉格雷的患者与接受氯吡格雷的患者的MACEs和出血发生率。
在10分钟（P = 0.085）和1小时（P = 0.337）时，GPIs之间的血小板抑制无统计学显著差异。在24小时时，与替罗非班（28 [3 - 56]%；P < 0.0001）和依替巴肽（44 [31 - 63]%；P = 0.007）相比，阿昔单抗的中位[四分位间距]血小板抑制在统计学上显著更高（75 [65 - 88]%）。根据所给予的GPI或P2Y12抑制剂，出血或MACEs无差异。
糖蛋白受体抑制剂在10分钟和1小时时达到相似水平的血小板抑制；然而，阿昔单抗在推注剂量后24小时仍保持这一效果。在现代，我们未观察到给予新型强效P2Y12抑制剂和GPI的患者出血率增加。
