Department of Pharmacy Services, Mayo Clinic, Rochester, Minnesota.
Department of Pharmacy Services, Mayo Clinic, Rochester, Minnesota.
Am J Cardiol. 2019 Jan 1;123(1):44-49. doi: 10.1016/j.amjcard.2018.09.029. Epub 2018 Sep 26.
Potent platelet inhibition is one of the most important medical interventions to prevent ischemic complications during and after percutaneous coronary intervention (PCI). Practice has evolved with the introduction of potent oral P2Y inhibitors that provide quick, effective platelet inhibition, and the need for routine glycoprotein IIb/IIIa inhibitors (GPIs) has decreased. Additionally, a shorter duration of GPI infusion has been shown to be safe with adequate oral antiplatelet loading, but clinical outcome data are limited to eptifibatide. This single-center, retrospective cohort study analyzed in-hospital outcomes for patients who received adjunctive GPI therapy for PCI before and after an institution-wide switch to high-dose bolus tirofiban with shortened infusion from short-duration eptifibatide. The primary end point was a composite in-hospital outcome of major and minor bleeding and cardiovascular events (death, myocardial infarction, coronary artery bypass grafting, ischemic stroke, and target vessel revascularization). Secondary end points included bleeding and cardiovascular event types. A total of 357 and 446 patients received eptifibatide and tirofiban, respectively, from February 1, 2014 through September 30, 2017. Thirty five eptifibatide and 46 tirofiban patients experienced an in-hospital composite event (9.8% vs 10.3%, p = 0.81). There was no difference found between in-hospital bleeding (6.4% vs 5.4%, p = 0.52) or cardiovascular events (5.6% vs 6.5%, p = 0.60) with the use of eptifibatide or tirofiban, respectively. Multivariable analysis showed that patients with transradial access or an indication of unstable angina were less likely to experience an in-hospital composite event (OR 0.30 and 0.19, respectively, p <0.001 for both). In conclusion, the use of high-dose bolus tirofiban with shortened infusion versus short-duration eptifibatide was not associated with an increase of in-hospital bleeding or cardiovascular events.
强效血小板抑制是预防经皮冠状动脉介入治疗（PCI）期间和之后发生缺血性并发症的最重要的医学干预措施之一。随着强效口服 P2Y 抑制剂的引入，实践已经发生了变化，这些抑制剂能快速、有效地抑制血小板，而常规使用糖蛋白 IIb/IIIa 抑制剂（GPI）的需求已经减少。此外，已有研究表明，在充分的口服抗血小板负荷治疗下，较短时间的 GPI 输注是安全的，但临床结果数据仅限于依替巴肽。这项单中心、回顾性队列研究分析了在机构范围内改用高剂量替罗非班推注并缩短依替巴肽输注时间后，接受辅助 GPI 治疗的 PCI 患者的住院期间结局。主要终点是主要和次要出血以及心血管事件（死亡、心肌梗死、冠状动脉旁路移植术、缺血性卒中和靶血管血运重建）的复合住院结局。次要终点包括出血和心血管事件类型。共有 357 例和 446 例患者分别于 2014 年 2 月 1 日至 2017 年 9 月 30 日期间接受依替巴肽和替罗非班治疗。35 例依替巴肽患者和 46 例替罗非班患者发生院内复合事件（9.8%比 10.3%，p=0.81）。依替巴肽和替罗非班的院内出血（6.4%比 5.4%，p=0.52）或心血管事件（5.6%比 6.5%，p=0.60）之间无差异。多变量分析显示，经桡动脉入路或不稳定型心绞痛指征的患者发生院内复合事件的可能性较小（OR 分别为 0.30 和 0.19，两者均＜0.001）。总之，与使用短时间依替巴肽相比，使用高剂量替罗非班推注并缩短输注时间与院内出血或心血管事件增加无关。
