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Hasanpour M, Maleki S, Rezaee H, Aminzadeh B, Abbasi Shaye Z, Keykhosravi E. Glycoprotein IIb/IIIa inhibitors in the treatment of thromboembolic events related to endovascular treatment of cerebral aneurysms-systematic review and meta-analysis. Neuroradiol J 2024; 37:152-163. [PMID: 36961079 PMCID: PMC10973825 DOI: 10.1177/19714009231166090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND AND AIMS Thromboembolism complication is considered the most common complication associated with the treatment of endovascular. This systematic review and meta-analysis aimed to assess the studies investigating the effect of glycoprotein IIb/IIIa inhibitor agents on thromboembolic complications during endovascular aneurysm coiling. MATERIALS AND METHODS This systematic review investigated the outcome of the use of three glycoprotein IIb/IIIa inhibitor agents (ie abciximab, tirofiban, and eptifibatide) on the thromboembolic complications during endovascular aneurysm coiling. The electronic databases of PubMed, Web of Science, Scopus, and Medline were searched up to 25 June 2021, using the keywords "Abciximab," "Tirofiban," and "Eptifibatide" incombination with "Thromboembolism Complication," "Aneurysms," and "Endovascular Aneurysm Coiling." RESULTS A total of 21 articles were found to be eligible and included in this review. The rates of complete and partial recanalization were estimated to be 56% and 92% in patients who underwent abciximab and tirofiban therapy, respectively. Rupture aneurysms were found in the majority of patients. In general, the mortality rate of the patients treated for thromboembolic complications during endovascular treatment of cerebral aneurysms with glycoprotein IIb/IIIa inhibitors was found to be 4.8% (CI 95%:0.027-0.067; p < .005). The average remission rate in studies investigating thromboembolism was 91% (CI 95%:0.88-0.95, I2 : 65.65/p < .001). CONCLUSION Based on the obtained results, a higher mean rate of complete recanalization by eptifibatide was found in studies in which abciximab or tirofiban were used, compared to other mentioned agents. Moreover, the amount of hemorrhage was reported to be less after using tirofiban rather than abciximab.
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Affiliation(s)
- Mohammad Hasanpour
- Division of Vascular and Endoovascular Neurosurgery, Firoozgar Hospital, Faculty of medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Samane Maleki
- Department of Radiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Rezaee
- Department of Neurosurgery, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behzad Aminzadeh
- Department of Radiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Abbasi Shaye
- Akbar Clinical research and Development Unit, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ehsan Keykhosravi
- Department of Neurosurgery, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Gao X, Zhang T, Huang X, Huan X, Li Y. Impact of rise and fall phases of shear on platelet activation and aggregation using microfluidics. J Thromb Thrombolysis 2024; 57:576-586. [PMID: 38556576 DOI: 10.1007/s11239-024-02968-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2024] [Indexed: 04/02/2024]
Abstract
Blood flow disorders are often the result of the non-physiological narrowing of blood arteries caused by atherosclerosis and thrombus. The blood then proceeds through rising-peak-decreasing phases as it passes through the narrow area. Although abnormally high shear is known to activate platelets, the shear process that platelets undergo in small arteries is complex. Thus, understanding how each shear phase affects platelet activation can be used to improve antiplatelet therapy and decrease the risk of side effects like bleeding. Blood samples were sheared (68.8 ms,5200 s-1) in vitro by the microfluidic technique, and platelet activation levels (P-selectin and integrin αIIbβ3) and von Willebrand factor (vWF) binding to platelets were analyzed by flow cytometry. Post-stenosis platelet aggregation was dynamically detected using microfluidic technology. We studied TXA2, P2Y12-ADP, and integrin αIIbβ3-fibrinogen receptor pathways by adding antiplatelet drugs, such as acetylsalicylic acid (ASA, an active ingredient of aspirin that inhibits platelet metabolism), ticagrelor (hinders platelet activation), and tirofiban (blocks integrin αIIbβ3 receptor) in vitro, respectively, to determine platelet activation function mediated by transient non-physiological high shear rates. We demonstrated that platelets can be activated under transient pathological high shear rates. The shear rise and fall phases influenced shear-induced platelet activation by regulating the binding of vWF to platelets. The degree of platelet activation and aggregation increased with multiple shear rise and fall phases. ASA did not inhibit shear-mediated platelet activation, but ticagrelor and tirofiban effectively inhibited shear-mediated platelet activation. Our data demonstrated that the shear rise and fall phases play an important role in shear-mediated platelet activation and promote platelet activation and aggregation in a vWF-dependent manner. Blocking integrin αIIbβ3 receptor and hindering P2Y12-ADP were beneficial to reducing shear-mediated platelet activation.
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Affiliation(s)
- Xuemei Gao
- Central Laboratory of Yong-Chuan Hospital, Chongqing Medical University, Chongqing, China
| | - Tiancong Zhang
- Department of Laboratory, West China Hospital, Sichuan University, Sichuan, China
| | - Xiaojing Huang
- Central Laboratory of Yong-Chuan Hospital, Chongqing Medical University, Chongqing, China
| | - Xuanrong Huan
- Department of Clinical Laboratory of Yong-Chuan Hospital, Chongqing Medical University, Chongqing, China
| | - Yuan Li
- Central Laboratory of Yong-Chuan Hospital, Chongqing Medical University, Chongqing, China.
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Garayzade R, Berlis A, Schiele S, Ertl M, Schneider H, Müller G, Maurer CJ. Efficacy and Safety Outcomes for Acute Ischemic Stroke Patients Treated with Intravenous Infusion of Tirofiban After Emergent Carotid Artery Stenting. Clin Neuroradiol 2024; 34:163-172. [PMID: 37796321 PMCID: PMC10881598 DOI: 10.1007/s00062-023-01350-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 09/14/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION Emergent stenting of the extracranial internal carotid artery (ICA) in stroke patients requires antiplatelet therapy to prevent in-stent thrombosis with a higher risk of intracranial haemorrhage. AIM OF THE STUDY Assess the efficacy and safety of emergent carotid stenting with intravenous tirofiban in acute ischemic stroke patients. METHODS Primary endpoint: symptomatic hemorrhage. Secondary endpoints: 90-day functional outcome and mortality. RESULTS Of the 62 patients, 21 (34%) received tirofiban as a single antiplatelet, and 41 (66%) received combined therapy. Premedication with anticoagulants and antiplatelets was significantly more frequent in the tirofiban-only group. The rate of symptomatic haemorrhage was significantly lower in the tirofiban-only group than in the combined group (4.8% vs. 27%, p = 0.046). The patients with tirofiban alone had a significantly better functional outcome at day 90 than the combined group (52% vs. 24%, p = 0.028). Mortality was equal (24%) in both groups. Pre-interventional NIHSS score (p = 0.003), significant blood pressure fluctuations (p = 0.012), tandem occlusion (p = 0.023), and thrombolysis (p = 0.044) showed relevant influence on the rate of symptomatic hemorrhage in the entire patient cohort. CONCLUSIONS A single antiplatelet therapy with tirofiban regardless of the premedication may improve the functional outcome in patients with stroke due to acute extracranial carotid lesion and emergent carotid stenting with lower rates of serious intracranial haemorrhage. For patients with high pre-interventional NIHSS score, tandem occlusion and after pre-interventional thrombolysis, caution is advised. Additionally, strict blood pressure monitoring should be conducted during the first 72 h after intervention.
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Affiliation(s)
- Rana Garayzade
- Department of diagnostic and interventional Radiology and Neuroradiology, Augsburg University Hospital, Augsburg, Germany.
| | - Ansgar Berlis
- Department of diagnostic and interventional Radiology and Neuroradiology, Augsburg University Hospital, Augsburg, Germany
| | - Stefan Schiele
- Institute of Mathematics, Augsburg University, Augsburg, Germany
| | - Michael Ertl
- Department of Neurology, Augsburg University Hospital, Augsburg, Germany
| | - Hauke Schneider
- Department of Neurology, Augsburg University Hospital, Augsburg, Germany
| | - Gernot Müller
- Institute of Mathematics, Augsburg University, Augsburg, Germany
| | - Christoph J Maurer
- Department of diagnostic and interventional Radiology and Neuroradiology, Augsburg University Hospital, Augsburg, Germany
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Cho KC, Son NH, Gwon SH, Choi JW, Jung WS. The safety and efficacy of intra-arterial low-dose tirofiban administration during endovascular therapy in patients with large ischemic core volume. Sci Rep 2024; 14:3353. [PMID: 38336813 PMCID: PMC10858233 DOI: 10.1038/s41598-024-53715-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 02/04/2024] [Indexed: 02/12/2024] Open
Abstract
This study aimed to evaluate the safety and efficacy of intra-arterial (IA) administration of low- dose tirofiban during endovascular therapy in patients with large ischemic core volumes on initial brain CT. Patients were divided into two groups based on the use of IA tirofiban. We identified 87 patients (16 and 71 patients in the tirofiban and no-tirofiban groups, respectively) with acute ischemic stroke due to intracranial artery occlusion who underwent endovascular therapy with a low Alberta Stroke Program Early CT scores (2-5). Multivariate logistic regression analysis revealed no association between IA tirofiban administration and serious postprocedural hemorrhagic complications (adjusted odds ratio (aOR), 0.720; 95% confidence interval (CI) 0.099-5.219; p = 0.960), any radiologic hemorrhage (aOR 0.076; 95% CI 0.003-2.323; p = 0.139), or 3-month mortality (aOR, 0.087; 95% CI 0.005-1.501; p = 0.093). However, IA tirofiban was associated with a lower 90-day mRS score (aOR, 0.197; 95% CI 0.015-1.306; p = 0.017) and change of NIHSS compared with baseline (aOR, 0.698; 95% CI 0.531-0.917; p = 0.010). IA tirofiban administration during endovascular therapy in patients with large ischemic core volumes may be effective and safe.
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Affiliation(s)
- Kwang-Chun Cho
- Department of Neurosurgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, South Korea
| | - Nak-Hoon Son
- Department of Statistics, Keimyung University, Daegu, South Korea
| | - So Hyeon Gwon
- Department of Statistics, Keimyung University, Daegu, South Korea
| | - Jin Wook Choi
- Department of Radiology, Ajou University Hospital, Ajou University College of Medicine, 164, World Cup-Ro, Yeongtong-Gu, Suwon, 16499, South Korea
| | - Woo Sang Jung
- Department of Radiology, Ajou University Hospital, Ajou University College of Medicine, 164, World Cup-Ro, Yeongtong-Gu, Suwon, 16499, South Korea.
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Sharma YP, Batta A, Rambabu E, Jaiswal B, Bhogal S, Gupta H, Mehrotra S, Panda P. [Efficacité du tirofiban intracoronaire avant pose d'un stent suivi d'une perfusion dans une charge de thrombus importante prouvée par angiographie : une étude randomisée]. Ann Cardiol Angeiol (Paris) 2023; 72:101609. [PMID: 37270883 DOI: 10.1016/j.ancard.2023.101609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 04/22/2023] [Accepted: 05/10/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND The presence of angiographic thrombus is associated with poor outcomes in contemporary cardiology practice. Percutaneous coronary intervention (PCI) in such lesions is associated with slow flow and no-reflow phenomenon which translate into poor clinical outcomes. METHODS This was a single-centre, prospective, open-label, randomized controlled study with 50 patients each in intervention group and control group. Patients with angiographically proven large thrombus burden were recruited. In the intervention group, patients were given loading dose of intracoronary tirofiban (25 mcg/kg infused over 5 minutes) followed by prolonged infusion of tirofiban (0.15 mcg/kg/min for 12-18 hours) followed by PCI after 48-72 hours interval. In control group patients were taken up directly for PCI during the index procedure. Outcomes were assessed angiographically and in terms of clinical endpoints. RESULTS The primary composite-endpoint of recurrent angina, myocardial infarction, cardiovascular death, target lesion revascularization and unscheduled CABG was significantly lower in the intervention arm compared to control arm (4% vs 16%, p = 0.04). Amongst the secondary endpoints, a statistically significant 30-day increase in ejection fraction from baseline was observed in the intervention group compared to the control group (1.6 ± 1.3 vs 0.2 ± 0.4, p = 0.0001). Overall mortality was similar in the two groups (4% vs 8%, p = 0.39). The primary safety endpoint of major bleeding was also similar in the 2 groups (2% vs 0%, p = 0.31). CONCLUSIONS Tirofiban use prior to PCI in high thrombus burden was associated with improved clinical and angiographic endpoints with similar adverse events compared to controls.
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Affiliation(s)
- Yash Paul Sharma
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh-160012, India
| | - Akash Batta
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, India
| | - Eslavath Rambabu
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh-160012, India
| | - Bhavuk Jaiswal
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, 141001, India
| | - Sukhdeep Bhogal
- Department of Interventional Cardiology, MedStar Washington Hospital Centre, 110 Irving St. Suite 4B-1, Washington, NWDC, 20010, USA
| | - Himanshu Gupta
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh-160012, India
| | - Saurabh Mehrotra
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh-160012, India
| | - Prashant Panda
- Department of Cardiology, Advanced Cardiac Centre, Post Graduate Institute of Medical Education & Research, Chandigarh-160012, India.
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Yuan X, Jiang P, Qiao C, Su N, Sun P, Lin F, Li C. PLATELET SUPPRESSION BY TIROFIBAN AMELIORATES PULMONARY COAGULATION AND FIBRINOLYSIS ABNORMALITIES IN THE LUNGS OF MOUSE ANTIBODY-MEDIATED TRANSFUSION-RELATED ACUTE LUNG INJURY. Shock 2023; 59:603-611. [PMID: 36640155 DOI: 10.1097/shk.0000000000002080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
ABSTRACT This study aimed to explore the ameliorating effects of the platelet surface glycoprotein IIb/IIIa receptor antagonist tirofiban on coagulation and fibrinolytic abnormalities in a mouse model of antibody-mediated transfusion-associated acute lung injury (ALI). This is important because ALI is a major cause of death attributable to the occurrence of adverse transfusion reactions. No information on a definite diagnosis or pathological mechanism exists, and targeted treatment options are not available. In this study, wild-type male Balb/c mice aged 8 to 10 weeks were randomly divided into the TRALI model, blank control, tirofiban intervention, and isotype control groups. After different treatment exposures, the mice were observed for 2 h before being killed, and lung tissue samples were collected. To explore the intervention effect of tirofiban, the degree of lung injury was quantified by estimating the lung wet/dry ratio, rectal temperature, survival rate, total protein, and myeloperoxidase and via hematoxylin-eosin staining. Furthermore, the coagulation, anticoagulation, and fibrinolysis assays were measured by automatic coagulation instrument and enzyme-linked immunosorbent assay kits, and the fluorescence densities of platelets and fibrin were quantified using immunofluorescence to analyze the effects of tirofiban on the platelet and fibrin interactions of TRALI. Compared with the TRALI model group, the lung injury indices in the tirofiban intervention group decreased significantly, and survival rates also improved. Furthermore, the level of coagulation and fibrinolytic abnormalities were obviously lower than those in the TRALI model group. In conclusion, our findings suggest that tirofiban might interfere with TRALI by inhibiting platelet activation and improving coagulation and fibrinolytic abnormalities.
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Affiliation(s)
- Xin Yuan
- Institute of Blood Transfusion, Chinese Academy of Medical Science & Peking Union Medical College, Chengdu, Sichuan, People's Republic of China
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Shang X, He C, Yang K, Guo Y, Zhou Z, Zi W. Effects of Antecedent Intravenous Thrombolysis on Endovascular Treatment of Acute Stroke Using Tirofiban. J Vasc Interv Radiol 2023; 34:420-426. [PMID: 36509235 DOI: 10.1016/j.jvir.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 11/18/2022] [Accepted: 12/01/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To investigate whether preceding intravenous thrombolysis combined with tirofiban in patients with acute ischemic stroke undergoing endovascular treatment is safe and effective. MATERIALS AND METHODS Consecutive data were identified for patients who experienced acute ischemic stroke and were admitted to 2 comprehensive stroke centers from January 2015 to August 2021. All patients were divided into 2 groups-a thrombolytic with tirofiban group and a tirofiban-alone group-on the basis of whether intravenous thrombolysis before emergency endovascular angioplasty was used. Multivariate regression and propensity adjustment analyses were performed to characterize differences in safety and clinical outcomes between the 2 groups. RESULTS Of 373 eligible patients, 111 (29.7%) were treated with thrombolysis with tirofiban. There was a significant difference in the rate of any intracerebral hemorrhage (35.1% vs 24.8%; P = .04) but not in the rates of symptomatic intracerebral hemorrhage (16.2% vs 11.5%; P = .23) and reocclusion at 24 hours (5.4% vs 7.6%; P = .51) between the 2 groups. Multivariate regression analysis revealed that intravenous thrombolysis was not associated with any or symptomatic intracerebral hemorrhage, artery occlusion, functional outcome, or death at the 3-month follow-up (all adjusted P > .05). After propensity adjustment, the thrombolytic with tirofiban group showed nonsignificant rates of clinical and safety outcomes compared with those of the tirofiban-alone group (all P > .05). CONCLUSIONS Tirofiban may be used without increasing the risk of adverse events in selected patients who experienced ischemic stroke and were treated with intravenous thrombolysis and endovascular therapy.
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Affiliation(s)
- Xianjin Shang
- Department of Neurology, the First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Caifeng He
- Department of Dermatology, the First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Ke Yang
- Department of Neurology, the First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Yapeng Guo
- Department of Neurology, the First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Zhiming Zhou
- Department of Neurology, the First Affiliated Hospital (Yijishan Hospital) of Wannan Medical College, Wuhu City, Anhui Province, China
| | - Wenjie Zi
- Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Shapingba District, Chongqing, China.
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Jiang C, Gao J, Luo DL, Guo JT. Treatment of intravenous thrombolysis with half dose recombinant human prourokinase reducing the rate of tirofiban use during early routine catheterization period. Asian J Surg 2022; 45:1414-1415. [PMID: 35440391 DOI: 10.1016/j.asjsur.2022.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 04/06/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Chao Jiang
- Chengde Medical University, Chengde, Hebei, China
| | - Jie Gao
- Chengde Medical University, Chengde, Hebei, China
| | - Dong-Lei Luo
- Department of Cardiology, Chengde Central Hospital/Second Clinical College of Chengde Medical University, Chengde, Hebei, China.
| | - Jing-Tao Guo
- Department of Cardiology, Chengde Central Hospital/Second Clinical College of Chengde Medical University, Chengde, Hebei, China.
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Murali Krishnam Raju P, Shyamala P, Venkata Narayana B, Kondra S, Mantena BPV. Assay of tirofiban and identification of oxidative impurity in aqueous injection by using UPLC-PDA/QDa detectors. Ann Pharm Fr 2021; 80:35-47. [PMID: 34153240 DOI: 10.1016/j.pharma.2021.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 06/08/2021] [Accepted: 06/14/2021] [Indexed: 11/19/2022]
Abstract
The basic objective of this study is to propose a short, reliable, mass compatible ultra-performance liquid chromatography (UPLC) method to confirm the identity of impurities and to estimate the assay and purity of Tirofiban simultaneously in aqueous injection (5mg/100mL bag). Aqueous formulations are susceptible to oxidation, hence the possible oxidative degradation impurities of Tirofiban were studied in this experiment by using UPLC coupled with photodiode array/Quadrupole Dalton Analyzer (PDA/QDa) detectors. The required separations were achieved in the column: ACQUITY HSS T3 (100×2.1) mm, 1.7μm, operated at 30°C by using 0.02% Triethyl amine (TEA) in water, pH 2.8 with formic acid as solution-A and 0.1% formic acid in 9:1 acetonitrile, water as solution-B. Binary gradient flow is delivered at the rate of 0.5mL/min and the detection of impurities specifically carried out at 227nm using empower3 software. RP-UPLC/PDA with QDa detector was used for the experiment. The method was linear and accurate from the concentrations: 0.04 to 0.38μg/mL for impurity-A and 0.04 to 75μg/mL for Tirofiban. The major unknown degradation impurity generated during the oxidative degradation has been identified as N-oxide derivative (Impurity-B) [(M+H)+ 455.1] by using QDa detector operated in an electro spray positive ion mode by applying a voltage of 0.8kV. This method was further validated as per ICH Q2 (R2) guidelines. Hence, the proposed method is said to be a fast, sensitive and comprehensive technique, which could give a clear idea about the assay and impurity profile of Tirofiban injection.
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Affiliation(s)
- P Murali Krishnam Raju
- Department of Physical, Nuclear Chemistry & Chemical Oceanography, School of Chemistry, Andhra University, Visakhapatnam, 530003 Andhra Pradesh, India; Aurobindo Pharma Limited, Bachupally, R.R District, Hyderabad, 500090 Telangana, India
| | - P Shyamala
- Department of Physical, Nuclear Chemistry & Chemical Oceanography, School of Chemistry, Andhra University, Visakhapatnam, 530003 Andhra Pradesh, India.
| | - B Venkata Narayana
- Aurobindo Pharma Limited, Bachupally, R.R District, Hyderabad, 500090 Telangana, India
| | - S Kondra
- Aurobindo Pharma Limited, Bachupally, R.R District, Hyderabad, 500090 Telangana, India
| | - B P V Mantena
- Aurobindo Pharma Limited, Bachupally, R.R District, Hyderabad, 500090 Telangana, India
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Piscopo A, Zanaty M, Hasan D. In Reply: Tirofiban Protocol Protects Against Delayed Cerebral Ischemia: A Case-Series Study. Neurosurgery 2021; 88:E455. [PMID: 33555023 DOI: 10.1093/neuros/nyab007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Accepted: 12/11/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- Anthony Piscopo
- Department of Neurosurgery University of Iowa Hospital and Clinics Iowa City, Iowa, USA
| | - Mario Zanaty
- Department of Neurosurgery University of Iowa Hospital and Clinics Iowa City, Iowa, USA
| | - David Hasan
- Department of Neurosurgery University of Iowa Hospital and Clinics Iowa City, Iowa, USA
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Sun Y, Guo ZN, Yan X, Wang M, Zhang P, Qin H, Wang Y, Zhu H, Yang Y. Safety and efficacy of tirofiban combined with endovascular therapy compared with endovascular therapy alone in acute ischemic stroke: a meta-analysis. Neuroradiology 2020; 63:17-25. [PMID: 32844236 DOI: 10.1007/s00234-020-02530-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Accepted: 08/17/2020] [Indexed: 12/31/2022]
Abstract
Endovascular treatment (EVT) has been widely used for treating acute ischemic stroke (AIS). However, the safety and efficacy of treating AIS with tirofiban combined with EVT remain controversial. Therefore, we conducted a meta-analysis to evaluate this treatment. Randomized controlled trials and cohort studies that compared treatment with tirofiban combined with EVT and EVT alone were included in our meta-analysis. Those published from inception to March 31, 2020, were searched using the PubMed, Web of Science, Embase, and Cochrane Library databases. Safety was assessed based on symptomatic intracranial hemorrhage (sICH) incidence and 3-month mortality. Efficacy was assessed based on modified Rankin Scale (mRS) scores at 3 months post-EVT and recanalization rates. Data were analyzed using either the random-effects or fixed-effects model based on the heterogeneity of studies. In total, one RCT, six prospective studies, and four retrospective studies (2387 AIS cases) were assessed. Our meta-analysis showed that tirofiban combined with EVT did not increase sICH risk (RR, 1.06; 95%CI, 0.79 to 1.42; P = 0.72) and 3-month mortality (RR, 0.87; 95%CI, 0.74 to 1.04; P = 0.12). Recanalization rates were not significantly different between patients treated with tirofiban combined with EVT and those treated with EVT alone (RR, 1.04; 95%CI, 1.00 to 1.08; P = 0.07), but tirofiban combined with EVT was significantly associated with favorable functional outcomes (mRS score, 0-2) in AIS patients (RR, 1.13; 95%CI, 1.02 to 1.25; P = 0.02). Tirofiban combined with EVT appears to be safe and potentially effective in treating AIS.
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Affiliation(s)
- Yingying Sun
- Neuroscience Center & Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Xinmin Street, Chang Chun, Jilin, 130021, China
| | - Zhen-Ni Guo
- Neuroscience Center & Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Xinmin Street, Chang Chun, Jilin, 130021, China
| | - Xiuli Yan
- Neuroscience Center & Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Xinmin Street, Chang Chun, Jilin, 130021, China
| | - Meiqi Wang
- Neuroscience Center & Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Xinmin Street, Chang Chun, Jilin, 130021, China
| | - Peng Zhang
- Neuroscience Center & Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Xinmin Street, Chang Chun, Jilin, 130021, China
| | - Haiqiang Qin
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Yan Wang
- Neuroscience Center & Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Xinmin Street, Chang Chun, Jilin, 130021, China
| | - Hongjing Zhu
- Neuroscience Center & Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Xinmin Street, Chang Chun, Jilin, 130021, China
| | - Yi Yang
- Neuroscience Center & Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Xinmin Street, Chang Chun, Jilin, 130021, China.
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Lee D, Lee DH, Park JC, Shin JH, Song Y, Chung J, Sheen JJ, Suh DC. Timing of Thrombosis in Embolization of Unruptured Intracranial Aneurysms : Tirofiban as Rescue Treatment. Clin Neuroradiol 2020; 31:125-133. [PMID: 31970464 DOI: 10.1007/s00062-019-00873-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 12/19/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE Thrombosis is one of the main complications of endovascular treatment for unruptured intracranial aneurysms (UIA). This article reports the timing and initial location of thrombosis and prognosis after the use of tirofiban for performing coil embolization for UIA. METHODS This study retrospectively collected 1686 cases of intracranial aneurysms treated with coil embolization from January 2013 to February 2018. Ruptured cases were excluded. The presumed causes and timing of thrombosis, the response after tirofiban administration and the modified Rankin scale (mRS) score at 3 months were reviewed. RESULTS Of the 26 patients 76% were female and middle cerebral artery and basilar artery aneurysms accounted for 7 cases. The initial location of thrombosis was related to the stent (n = 14, 53.8%) or coil (n = 12, 46.2%). Of the patients 19 (73.1%) developed thrombosis during the procedure, and 5 patients (19.2%) developed it within 1 day of the procedure. Median duration between the thrombotic procedure and initial thrombosis was 38.5 min, 12 patients were symptomatic but more than half completely recovered after using tirofiban. Good clinical outcome (mRS 0-2) was seen in 92.3%. In the subgroup analysis, median time from the first thrombotic procedure to initial thrombosis within 1 day was 38.0 min (stent-related group) and 35.0 min (coil-related group, p = 0.651). CONCLUSION In most cases of embolization for UIA, thrombosis requiring the use of tirofiban occurs intraprocedurally or on the first day after the procedure. Careful observation of thrombosis during the procedure is important and tirofiban should be used for a better outcome even if the infarction progresses.
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Affiliation(s)
- Dongwhane Lee
- Department of Neurology, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea (Republic of)
| | - Deok Hee Lee
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 05505, Seoul, Korea (Republic of).
| | - Jung Cheol Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea (Republic of)
| | - Jae Ho Shin
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea (Republic of)
| | - Yunsun Song
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 05505, Seoul, Korea (Republic of)
| | - Jaewoo Chung
- Department of Neurosurgery, Dankook University Hospital, Cheonan, Korea (Republic of)
| | - Jae Jon Sheen
- Department of Neurosurgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Uijeongbu, Korea (Republic of)
| | - Dae Chul Suh
- Department of Radiology, Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, 05505, Seoul, Korea (Republic of)
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Chang ST, Yang YT, Chu CM, Pan KL, Hsu JT, Hsiao JF, Lin YS, Chung CM. Protein kinases are involved in the cardioprotective effects activated by platelet glycoprotein IIb/IIIa inhibitor tirofiban at reperfusion in rats in vivo. Eur J Pharmacol 2018; 832:33-38. [PMID: 29778748 DOI: 10.1016/j.ejphar.2018.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/11/2018] [Accepted: 05/16/2018] [Indexed: 11/15/2022]
Abstract
The thrombolytic effect of platelet glycoprotein IIb/IIIa inhibitors (GP IIb/IIIa inhibitors) in myocardial infarction has been well established. Nevertheless, data on the mechanism of the cardioprotective effect of GP IIb/IIIa inhibitors in ischemic-reperfusion injury (IR) are lacking. Sprague-Dawley rats received 120 min of coronary ischemia and 180 min of reperfusion. A GP IIb/IIIa inhibitor was given via continuous intravenous infusion at a rate of 2 μg/kg/min 30 min prior to reperfusion with/without inhibitors of PKCε (chelerythrine), PI3 kinase and Akt (wortmannin), p38 MAPK (SB203582), p42/44 MAPK (PD98059) and ERK1/2 (u0126) 15 min prior to the GP IIb/IIIa inhibitor. Protein isolation and analysis were performed by Western blot analysis. The cardioprotective effects were measured as the ratio of myocardial necrotic area to the area at risk (AAR) and the apoptotic index (AI) calculated as the percentage of myocytes positive for terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick-end labeling of all myocytes stained by 4', 6-diamidino-2-phenylindole. The GP IIb/IIIa inhibitor reduced the ratio of myocardial necrotic area to AAR and AI, and also exerted an immediate cardioprotective effect by activating multiple signaling pathways including phosphorylation and activation of PKCε, PI3 kinase, Akt, p38 MAPK, p42/44 MAPK and ERK1/2. However, there were no significant increases in the phosphorylation of Raf and MEK1/2. We concluded that the GP IIb/IIIa inhibitor reduced the extent of cardiac IR and significantly ameliorate the apoptosis of myocytes in the rats. In addition, the cardioprotective effect was mediated through the activation of multiple signal transduction pathways.
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Affiliation(s)
- Shih-Tai Chang
- Division of Cardiology, Chiayi Chang Gung Memorial Hospital, Chai Yi Hsien, Taiwan; Chiayi School, Chang Gung Institute of Technology, Chai Yi Hsien, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
| | - Ya-Ting Yang
- Section of Health Informatics, Institute of Public Health, National Defense Medical Center and University, Taipei, Taiwan
| | - Chi-Ming Chu
- Section of Health Informatics, Institute of Public Health, National Defense Medical Center and University, Taipei, Taiwan
| | - Kuo-Li Pan
- Division of Cardiology, Chiayi Chang Gung Memorial Hospital, Chai Yi Hsien, Taiwan; Chiayi School, Chang Gung Institute of Technology, Chai Yi Hsien, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Jen-Te Hsu
- Division of Cardiology, Chiayi Chang Gung Memorial Hospital, Chai Yi Hsien, Taiwan; Chiayi School, Chang Gung Institute of Technology, Chai Yi Hsien, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Ju-Feng Hsiao
- Division of Cardiology, Chiayi Chang Gung Memorial Hospital, Chai Yi Hsien, Taiwan; Chiayi School, Chang Gung Institute of Technology, Chai Yi Hsien, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology, Chiayi Chang Gung Memorial Hospital, Chai Yi Hsien, Taiwan; Chiayi School, Chang Gung Institute of Technology, Chai Yi Hsien, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Chang-Min Chung
- Division of Cardiology, Chiayi Chang Gung Memorial Hospital, Chai Yi Hsien, Taiwan; Chiayi School, Chang Gung Institute of Technology, Chai Yi Hsien, Taiwan; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
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Hu S, Wang H, Zhu J, Li M, Li H, Gao D, Zhang H. Effect of intra-coronary administration of tirofiban through aspiration catheter on patients over 60 years with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention. Medicine (Baltimore) 2018; 97:e10850. [PMID: 29794782 PMCID: PMC6393146 DOI: 10.1097/md.0000000000010850] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The aim of this study was to compare the efficacy and safety of 2 approaches for intra-coronary administration of tirofiban (aspiration catheter versus guiding catheter) in patients over 60 years of age undergoing percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI). It has been suggested that the administration of tirofiban by intra-coronary injection could promote drug absorption in the diseased region and enhance the inhibition of platelet aggregation, decreasing bleeding rates, but little is known about the comparative efficiency and safety of using guiding catheter versus aspiration catheter for delivery.Eighty-nine patients over 60 years of age with STEMI undergoing PCI were randomly divided into 2 groups according to the injection route for intracoronary administration of tirofiban [guiding catheter (n = 41) and aspiration catheter (n = 48)]. Baseline features, epicardial and myocardial perfusion, major adverse cardiac and cerebrovascular events (MACCEs), and bleeding rate were compared.No differences in age, gender, and history of hypertension, hypercholesterolemia, diabetes, and so on were observed (P > .05). The patients in the aspiration catheter group generally had a higher incidence of cerebral vascular disease. Compared with those in the guiding catheter group, patients in the aspiration catheter group obtained more favorable myocardial perfusion (P < .05). In-hospital and at 3-month and 6-month follow-ups, the MACCE rate and frequency of bleeding events were similar between the 2 groups (P > .05).Intra-coronary delivery of tirofiban through aspiration catheter led to better myocardial perfusion in STEMI patients over 60 years of age undergoing PCI compared with intra-coronary injection of tirofiban through guiding catheter. The 2 delivery routes were associated with similar rates of MACCEs and bleeding events.
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De Luca G, Smit JJ, Ernst N, Suryapranata H, Ottervanger JP, Hoorntje JCA, Dambrink JHE, Gosslink ATM, de Boer MJ, van 't Hof AWJ. Impact of adjunctive tirofiban administration on myocardial perfusion and mortality in patients undergoing primary angioplasty for ST-segment elevation myocardial infarction. Thromb Haemost 2017; 93:820-3. [PMID: 15886794 DOI: 10.1160/th04-11-0726] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummarySeveral studies have shown that suboptimal myocardial perfusion may be observed despite optimal epicardial recanalisation in patients undergoing primary angioplasty for ST-segment elevation myocardial infarction (STEMI), resulting in unfavourable outcome. The aim of the current study was to evaluate the benefits in myocardial perfusion and mortality from adjunctive tirofiban administration in patients undergoing primary angioplasty for (STEMI). A total of 1,969 patients with STEMI treated by primary angioplasty represent the population of the current study. All clinical, angiographic and follow-up data were prospectively collected. Tirofiban was administrated in 481 patients (24.4%) (all before angioplasty). Tirofiban was associated with less distal embolisation (11.7% vs 16.1%, p = 0.048), better postprocedural MBG 3 (50.9% vs 39.7%, adjusted p < 0.0001) and a significant reduction in 1-year mortality (3% vs 6.4%, adjusted p = 0.045). The benefits in mortality were confirmed in all subgroups identified according to the quartiles of the propensity score. This study shows that, when compared to control group, adjunctive tirofiban before primary angioplasty for STEMI is associated with better myocardial perfusion and a reduction in 1-year mortality.
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Affiliation(s)
- Giuseppe De Luca
- Department of Cardiology, ISALA Klinieken, Zwolle, The Netherlands
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Hölschermann H, Krombach C, Jung A, Jacobi F, Tillmanns H, Weinand F. Treatment of acute central retinal artery occlusion with the platelet glycoprotein IIb/IIIa receptor inhibitor tirofiban. Thromb Haemost 2017; 94:684-6. [PMID: 16268493 DOI: 10.1160/th05-03-0684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Derhaschnig U, Pachinger C, Schweeger-Exeli I, Marsik C, Jilma B. Blockade of GPIIb/IIIa by eptifibatide and tirofiban does not alter tissue factor induced thrombin generation in human endotoxemia. Thromb Haemost 2017; 90:1054-60. [PMID: 14652636 DOI: 10.1160/th03-04-0233] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryActivated platelets facilitate thrombin generation by providing a catalytic surface on which coagulation activation occurs. The glycoprotein (GP) IIb/IIIa receptor might play a major role in this process as shown by in vitro and animal experiments. However, it is controversial whether the GPIIb/IIIa receptor facilitates tissue factor-induced thrombin generation in humans as well. We therefore investigated whether two clinically used GPIIb/IIIa antagonists (tirofiban and eptifibatide) may blunt TF-induced coagulation in humans.Thirty male volunteers received 2 ng/kg endotoxin and standard doses of eptifibatide, tirofiban or placebo over 5 hours in a randomized, double-blind, placebo-controlled, double-dummy parallel-group trial. Markers of thrombin generation (prothrom-bin fragment 1+2, thrombin-antithrombin complexes), fibrinoly-sis (D-dimer, plasmin-antiplasmin complexes) as well as inflammatory markers (interleukin-6, tumor necrosis factor-α) were measured by enzyme linked immunoasssays, TF-mRNA expression was quantified by RT-PCR. Neither eptifibatide nor tirofiban influenced LPS-induced coagulation activation or fibrinolytic activity. Additionally, the increase of TNF-α and IL-6 was similar in all groups.In conclusion, GPIIb/IIIa blockade with eptifibatide or tirofiban did not influence TF-induced coagulation activation in human low grade endotoxemia.
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Affiliation(s)
- Ulla Derhaschnig
- Department of Clinical Pharmacology, University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria
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Siotia A, Buckland R, Judge HM, Sastry P, Storey RF. Utility of a whole blood single platelet counting assay to monitor the effects of tirofiban in patients with acute coronary syndromes scheduled for coronary intervention. Thromb Haemost 2017; 95:997-1002. [PMID: 16732379 DOI: 10.1160/th05-08-0544] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
SummaryThis study aimed to establish the utility of a whole-blood singleplatelet counting (WBSPC) assay, a measure of microaggregation, in monitoring the effects of tirofiban, comparing this with optical aggregometry (OA) and the Ultegra TRAP cartridge system (UTC), measures of macroaggregation. Fifty-nine patients with acute coronary syndrome scheduled for coronary angiography +/angioplasty were studied. WBSPC assay (ADP 0.3-100 µM, Sysmex KX21 analyzer), OA (ADP 20 µM) and UTC were performed: before starting tirofiban; 30 min, 4 and 24 h after starting tirofiban; and 1 and 2h after stopping tirofiban. Thirty minutes after starting tirofiban, there was substantial inhibition of platelet aggregation (40 ± 30%; WBSPC, 2 minutes after addition of ADP 30 µM) and this remained stable at 4 and 24 h. OA (86 ± 17%; inhibition of maximal aggregation,ADP 20 µM) and UTC (93 ± 7%) showed marked inhibition with less inter-individual variation. There was no significant correlation between OA and UTC results (R2 = 0.006), but fair correlation between OA and WBSPC results (R2 = 0.37). Greater inhibition of macroaggregation (OA and UTC) was seen compared to microaggregation (WBSPC) such that WBSPC was more discriminating in the therapeutic range when macroaggregation was often completely inhibited. A WBSPC assay of platelet microaggregation shows promise for monitoring GPIIb/IIIa antagonists.
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Affiliation(s)
- Anjan Siotia
- Cardiovascular Research Unit, University of Sheffield, Clinical Sciences Centre, Northern General Hospital, Sheffield, United Kingdom
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Sun B, Liu Z, Yin H, Wang T, Chen T, Yang S, Jiang Z. Intralesional versus intracoronary administration of glycoprotein IIb/IIIa inhibitors during percutaneous coronary intervention in patients with acute coronary syndromes: A meta-analysis of randomized controlled trials. Medicine (Baltimore) 2017; 96:e8223. [PMID: 28984776 PMCID: PMC5738012 DOI: 10.1097/md.0000000000008223] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Glycoprotein IIb/IIIa inhibitors (GPIs) have been regarded as an adjuvant regimen to deal with no-reflow. However, whether intralesional (IL) administration of GPIs improves myocardial reperfusion without increasing bleeding in patients with acute coronary syndrome (ACS) compared with intracoronary (IC) administration has not been well addressed. Our meta-analysis aimed to evaluate the efficacy and safety of IL versus IC administration of GPIs for patients with ACS during percutaneous coronary intervention. METHODS We systematically searched Medline, Embase, the Cochrane Central Register of Controlled Trials, and Cambridge Scientific Abstracts from January 2007 to May 2017. Thrombolysis in Myocardial Infarction (TIMI) 3 flow, corrected TIMI frame count (CTFC), and complete ST-segment resolution (>70%) were selected as the primary outcomes. Major adverse cardiac events (MACEs) were the secondary outcome, and major bleeding complications were the safety outcome. Data analysis was conducted using the Review Manager 5.3 software. RESULTS Six randomized controlled trials were included in our meta-analysis. Compared with IC, IL obtained better results in terms of TIMI grade 3 flow [odds ratio (OR) 2.29; 95% confidence intervals (CIs) 1.31-4.01; P = .004], CTFC [weighted mean difference (WMD) -4.63; 95% CI -8.82 to -0.43; P = .03], and complete ST-segment resolution (OR 1.55; 95% CI 1.12-2.14; P = .008). There was a trend toward decreased MACE in the IL administration groups, which was not of statistical significance (OR 0.63; 95% CI 0.30-1.31; P = .22). No significant difference was found between the two groups in terms of in-hospital major bleeding events (OR 2.52; 95% CI .66 to 9.62; P = .18). CONCLUSION IL administration yielded favorable outcomes in terms of myocardial tissue reperfusion as evidenced by the improved TIMI flow grade, CTFC, complete ST-segment resolution, and decreased MACE without increasing in-hospital major bleeding events. The IL administration of GPIs can be recommended as the preferred regimen to guard against no-reflow.
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Affiliation(s)
- Binjie Sun
- Department of Cardiology, The Third Hospital of Hebei Medical University
| | - Zhen Liu
- Department of Cardiology, The Third Hospital of Hebei Medical University
| | - Hongshan Yin
- Department of Cardiology, The Third Hospital of Hebei Medical University
| | - Tao Wang
- Department of Cardiology, The Third Hospital of Hebei Medical University
| | - Tao Chen
- Department of Cardiology, The Third Hospital of Hebei Medical University
| | - Sen Yang
- Department of Epidemiology and Health Statistics, Center for Disease Control and Prevention of Hebei Province, Shijiazhuang, P.R. China
| | - Zhian Jiang
- Department of Cardiology, The Third Hospital of Hebei Medical University
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Zhou X, Wu X, Sun H, Li J. Efficacy and safety of eptifibatide versus tirofiban in acute coronary syndrome patients: A systematic review and meta-analysis. J Evid Based Med 2017; 10:136-144. [PMID: 28449419 DOI: 10.1111/jebm.12253] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 03/21/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Glycoprotein IIb/IIIa inhibitors were the strongest available antiplatelet therapy and have been shown to reduce cardiac ischemic complications in patients undergoing percutaneous coronary intervention. However, evidences are still lacking on the superiority of eptifibatide over tirofiban or vice versa in patients with acute coronary syndrome. OBJECTIVE To compare the efficacy and safety of eptifibatide and tirofiban used among patients with acute coronary syndrome by performing a systematic review and meta-analysis of randomized controlled trials. METHODS A systematic search was conducted in Pubmed, Ovid/Medline, Ovid/Embase, Clinicaltrials.gov, CBM and CNKI to identify randomized controlled trials comparing eptifibatide with tirofiban for acute coronary syndrome until November 2015. The methodological quality was assessed with the Cochrane bias risk assessment tool. RESULTS 1256 patients from 9 randomized controlled trials were finally included. Compared with tirofiban, eptifibatide could reduce more risk of thrombolysis in myocardial infarction minor bleeding (RR 0.61, 95%CI 0.38, 0.98). However, no significant differences were observed for major adverse cardiac events (RR 0.41, 95%CI 0.15 to 1.12), major bleeding, thrombocytopenia in the two treatment groups. The relative treatment benefits were similar in subgroups of patients according to types of acute coronary syndrome, or undergoing percutaneous coronary intervention. CONCLUSION Available evidence suggests that the safety of eptifibatide is slightly superior to tirofiban in patients with acute coronary syndrome, but no significant difference was observed on efficacy. Future studies should focus on the randomized controlled trials with larger sample, multi-center, long-term follow-up, high quality to compare the two drugs.
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Affiliation(s)
- Xiaoqin Zhou
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Xinyu Wu
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Huan Sun
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China School of Medicine, Sichuan University, Chengdu, Sichuan, China
| | - Jing Li
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
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El-Bagary RI, Elkady EF, Farid NA, Youssef NF. Validated spectrofluorimetric methods for the determination of apixaban and tirofiban hydrochloride in pharmaceutical formulations. Spectrochim Acta A Mol Biomol Spectrosc 2017; 174:326-330. [PMID: 27984753 DOI: 10.1016/j.saa.2016.11.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 11/11/2016] [Accepted: 11/28/2016] [Indexed: 06/06/2023]
Abstract
Apixaban and Tirofiban Hydrochloride are low molecular weight anticoagulants. The two drugs exhibit native fluorescence that allow the development of simple and valid spectrofluorimetric methods for the determination of Apixaban at λ ex/λ em=284/450nm and tirofiban HCl at λ ex/λ em=227/300nm in aqueous media. Different experimental parameters affecting fluorescence intensities were carefully studied and optimized. The fluorescence intensity-concentration plots were linear over the ranges of 0.2-6μgml-1 for apixaban and 0.2-5μgml-1 for tirofiban HCl. The limits of detection were 0.017 and 0.019μgml-1 and quantification limits were 0.057 and 0.066μgml-1 for apixaban and tirofiban HCl, respectively. The fluorescence quantum yield of apixaban and tirofiban were calculated with values of 0.43 and 0.49. Method validation was evaluated for linearity, specificity, accuracy, precision and robustness as per ICH guidelines. The proposed spectrofluorimetric methods were successfully applied for the determination of apixaban in Eliquis tablets and tirofiban HCl in Aggrastat intravenous infusion. Tolerance ratio was tested to study the effect of foreign interferences from dosage forms excipients. Using Student's t and F tests, revealed no statistically difference between the developed spectrofluorimetric methods and the comparison methods regarding the accuracy and precision, so can be contributed to the analysis of apixaban and tirofiban HCl in QC laboratories as an alternative method.
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Affiliation(s)
- Ramzia I El-Bagary
- Pharmaceutical Chemistry Department, Faculty of Pharmaceutical Sciences and Pharmaceutical Industries, Future University, Egypt; Pharmaceutical Chemistry Department, Faculty of Pharmacy, Cairo University, Egypt
| | - Ehab F Elkady
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Cairo University, Egypt
| | - Naira A Farid
- Pharmaceutical Chemistry Department, National organization for Drug Control and Research (NODCAR), Giza, Egypt.
| | - Nadia F Youssef
- Pharmaceutical Chemistry Department, National organization for Drug Control and Research (NODCAR), Giza, Egypt
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Chaudhary HT. In-Silico Analysis of Amotosalen Hydrochloride Binding to CD-61 of Platelets. J Coll Physicians Surg Pak 2016; 26:881-886. [PMID: 27981920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Accepted: 10/09/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To determine the docking of Amotosalen hydrochloride (AH) at CD-61 of platelets, and to suggest the cause of bleeding in AH treated platelets transfusion. STUDY DESIGN Descriptive study. PLACE AND DURATION OF STUDY Medical College, Taif University, Taif, Saudi Arabia, from October 2014 to May 2015. METHODOLOGY The study was carried out in-silico. PDB (protein data bank) code of Tirofiban bound to CD-61 was 2vdm. CD-61 was docked with Tirofiban using online docking tools, i.e. Patchdock and Firedock. Then, Amotosalen hydrochloride and CD-61 were also docked. Best docking poses to active sites of 2vdm were found. Ligplot of interactions of ligands and CD-61 were obtained. Then comparison of hydrogen bonds, hydrogen bond lengths, and hydrophobic bonds of 2vdm molecule and best poses of docking results were done. Patchdock and Firedock results of best poses were also analysed using SPSS version 16. RESULTS More amino acids were involved in hydrogen and hydrophobic bonds in Patchdock and Firedock docking of Amotosalen hydrochloride with CD-61 than Patchdock and Firedock docking of CD-61 with Tirofiban. The binding energy was more in latter than former. CONCLUSION Amotosalen hydrochloride binds to the active site of CD-61 with weaker binding force. Haemorrhage seen in Amotosalen hydrochloride-treated platelets might be due to binding of Amotosalen hydrochloride to CD-61.
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Okmen E, Sanli A, Uyarel H, Dayi S, Tartan Z, Cam N. Impacts of Glycoprotein IIb/IIIa Inhibition on QT Dispersion After Successful Percutaneous Coronary Intervention. Angiology 2016; 57:273-81. [PMID: 16703187 DOI: 10.1177/000331970605700303] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Coronary ischemia augments inhomogeneity in ventricular repolarization. Decrease in the QT dispersion (QTd) following restoration of coronary blood flow to the ischemic myocardium by successful percutaneous coronary intervention (PCI) is an expected outcome. The purpose of the study was to seek whether glycoprotein IIb/IIIa (GP IIb/IIIa) inhibition has additional beneficial effects on QT dispersion after angiographically successful PCI. The study involved 111 consecutive patients scheduled for elective coronary balloon angioplasty with or without stent implantation. Sixty patients (mean age 58 ±9) were randomized to receive standard therapy including preprocedural aspirin, ticlopidine, and IV heparin, and 51 patients (mean age 54 ±10) were randomized to receive additional IV tirofiban infusion before the lesion was crossed with the guidewire. Standard 12-lead simultaneous ECG recordings for the measurement of QTd and corrected QTd (QTcd) (calculated by using Bazett’s formula) were obtained before and immediately after the procedure, and at the 6th, and 24th hours. Blood samples for detection of postprocedural myocardial damage (CK-MB and cTn-I) were taken before and immediately after the procedure, at the 6th, 12th, and 24th hours. In total, 128 stenoses were treated with PCI. Seventy of these lesions were in the standard therapy group and 58 in the tirofiban group. QTd and QTcd were not statistically different between the 2 groups before and immediately after the procedure and at the 6th hours, but at the 24th hour QTd and QTcd were significantly longer in the standard therapy group (p=0.047 and p=0.001, respectively). Postprocedural troponin-I elevation (B=0.692, p=0.037), maximum inflation pressure (B=0.182, p=0.001), and previous myocardial infarction (MI) (B=0.885, p=0.004) were defined as the predictors of the final QT dispersion at the 24th hour. QT dispersion significantly decreased after successful percutaneous coronary intervention. GP IIb/IIIa inhibition therapy was not superior by means of recovery of increased QT dispersion during the early hours of the intervention, but it prevented minor myocardial necrosis and provided more long-lasting recovery in QT dispersion as compared with heparin therapy. This impact of GP IIb/IIIa receptor inhibition on QTd may be a possible mechanism by which these drugs reduce cardiovascular events after PCI.
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Affiliation(s)
- Ertan Okmen
- Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey.
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Abstract
Platelet glycoprotein (GP) IIb/IIIa inhibitors prevent fibrinogen binding and platelet aggregation. Inhibition of platelet activity at the injured coronary plaque is a target for novel therapeutic strategies. They decrease ischemic complications associated with non-ST-segment elevation acute coronary syndromes and percutaneous coronary intervention. Thrombocytopenia is a serious complication well described with the use of the prototype GP IIb/IIIa inhibitor abciximab. Its association with other agents of this class has been underemphasized. It is important to monitor platelet counts closely after initiation of GP IIb/IIIa inhibitor therapy, not only for abciximab, but also for small molecule inhibitors such as eptifibatide and tirofiban. Monitoring of platelet counts at 2 to 6 hours and 24 hours will detect most cases of acute thrombocytopenia. Adverse events may be prevented by prompt discontinuation of GP IIb/IIIa inhibitor therapy. The authors present a case of profound thrombocytopenia after the administration of tirofiban in the treatment of a patient with an acute coronary syndrome.
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Affiliation(s)
- Saumil Patel
- Internal Medicine, Department of Medicine, New York Methodist Hospital, Brooklyn, 11215, USA
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Ding DD, Wang YH, Chen YH, Mei RQ, Yang J, Luo JF, Li Y, Long CL, Kong Y. Amides and neolignans from the aerial parts of Piper bonii. Phytochemistry 2016; 129:36-44. [PMID: 27452451 DOI: 10.1016/j.phytochem.2016.07.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 06/28/2016] [Accepted: 07/13/2016] [Indexed: 05/26/2023]
Abstract
Six amides, piperbonamides A-F, three neolignans piperbonins A-C, and 11 known compounds were isolated from the aerial parts of Piper bonii (Piperaceae). The structures of piperbonamides A-F and piperbonins A-C were elucidated based on the analysis of 1D and 2D NMR and MS data. Piperbonin A, (+)-trans-acuminatin, (+)-cis-acuminatin, (+)-kadsurenone, and pipernonaline showed weak activity against platelet aggregation with IC50 values of 118.2, 108.5, 90.02, 107.3, and 116.3 μM, respectively, as compared with the positive control, tirofiban, with an IC50 value of 5.24 μM. Piperbonamides A-F were inactive against five tumor cell lines at concentrations up to 40 μM.
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Affiliation(s)
- Duo-Duo Ding
- Key Laboratory of Economic Plants and Biotechnology, Yunnan Key Laboratory for Wild Plant Resources, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming 650201, People's Republic of China
| | - Yue-Hu Wang
- Key Laboratory of Economic Plants and Biotechnology, Yunnan Key Laboratory for Wild Plant Resources, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming 650201, People's Republic of China
| | - Ya-Hui Chen
- School of Life Science & Technology, China Pharmaceutical University, Nanjing 210009, People's Republic of China
| | - Ren-Qiang Mei
- Key Laboratory of Economic Plants and Biotechnology, Yunnan Key Laboratory for Wild Plant Resources, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming 650201, People's Republic of China
| | - Jun Yang
- Key Laboratory of Economic Plants and Biotechnology, Yunnan Key Laboratory for Wild Plant Resources, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming 650201, People's Republic of China
| | - Ji-Feng Luo
- Key Laboratory of Economic Plants and Biotechnology, Yunnan Key Laboratory for Wild Plant Resources, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming 650201, People's Republic of China
| | - Yan Li
- State Key Laboratory of Phytochemistry and Plant Resources in West China, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming 650201, People's Republic of China
| | - Chun-Lin Long
- Key Laboratory of Economic Plants and Biotechnology, Yunnan Key Laboratory for Wild Plant Resources, Kunming Institute of Botany, Chinese Academy of Sciences, Kunming 650201, People's Republic of China; College of Life and Environmental Sciences, Minzu University of China, Beijing 100081, People's Republic of China.
| | - Yi Kong
- School of Life Science & Technology, China Pharmaceutical University, Nanjing 210009, People's Republic of China.
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Tilgner J, von Trotha KT, Gombert A, Jacobs MJ, Drechsler M, Döring Y, Soehnlein O, Grommes J. Aspirin, but Not Tirofiban Displays Protective Effects in Endotoxin Induced Lung Injury. PLoS One 2016; 11:e0161218. [PMID: 27583400 PMCID: PMC5008681 DOI: 10.1371/journal.pone.0161218] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 08/02/2016] [Indexed: 12/28/2022] Open
Abstract
Background Treatment of acute lung injury (ALI) remains an unsolved problem in intensive care medicine. Recruitment of neutrophils into the lungs, regarded as a key mechanism in progression of ALI, depends on signaling between neutrophils and platelets. Consequently we explored the effect of platelet-targeted aspirin and tirofiban treatment in endotoxin induced acute lung injury Methods C57Bl/6 mice were exposed to aerosolized LPS (500μg/ml) for 30min and treated with Aspirin (100μg/g bodyweight via intraperitoneal injection, 30 min before or 1 hour after LPS inhalation) or Tirofiban (0.5μg/ g bodyweight via tail vein injection 30 min before or 1 hour after LPS inhalation). The count of alveolar, interstitial, and intravascular neutrophils was assessed 4h later by flow cytometry. Lung permeability changes were assessed by FITC-dextran clearance and protein content in the BAL fluid. Results Aspirin both before and after LPS inhalation reduced neutrophil influx into the lung and lung permeability indicating the protective role of Aspirin in ALI. Tirofiban, however, did not alter neutrophil recruitment after LPS inhalation. Release of platelet-derived chemokines CCL5 and PF4 and neutrophil extracellular traps was reduced by Aspirin but not by Tirofiban. Conclusion Aspirin, but not Tirofiban reduces neutrophil recruitment and displays protective effects during endotoxin induced lung injury.
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Affiliation(s)
- Jessica Tilgner
- European Vascular Center Aachen-Maastricht, Rhenish Westphalian Technical University Aachen, Aachen Germany
| | - Klaus Thilo von Trotha
- European Vascular Center Aachen-Maastricht, Rhenish Westphalian Technical University Aachen, Aachen Germany
| | - Alexander Gombert
- European Vascular Center Aachen-Maastricht, Rhenish Westphalian Technical University Aachen, Aachen Germany
| | - Michael J. Jacobs
- European Vascular Center Aachen-Maastricht, Rhenish Westphalian Technical University Aachen, Aachen Germany
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - Maik Drechsler
- Institute for Cardiovascular Prevention, Ludwig Maximillian University Munich, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Yvonne Döring
- Institute for Cardiovascular Prevention, Ludwig Maximillian University Munich, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Oliver Soehnlein
- Institute for Cardiovascular Prevention, Ludwig Maximillian University Munich, Munich, Germany
- Department of Pathology, University of Amsterdam, Amsterdam, The Netherlands
- German Centre for Cardiovascular Research (DZHK), Partner Site Munich Heart Alliance, Munich, Germany
| | - Jochen Grommes
- European Vascular Center Aachen-Maastricht, Rhenish Westphalian Technical University Aachen, Aachen Germany
- Institute for Cardiovascular Prevention, Ludwig Maximillian University Munich, Munich, Germany
- * E-mail:
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27
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Abstract
Ischemic stroke and reperfusion (ISR) is associated with an inflammatory response characterized, in part, by the formation of leukocyte-platelet aggregates (LPA). Aggregate formation may amplify the immunologic and hemostatic functions of both cell types and thus exacerbate reperfusion injury after ischemic stroke. LPA formation in peripheral blood may also serve as a biomarker of the severity of injury. However, it is not fully known whether ISR causes LPA formation that can be detected in the peripheral blood. Therefore, the purpose of this study was to measure LPA in the peripheral blood after ISR using a rat model. The filament method was used to perform ISR. Blood was collected from the jugular vein before ischemia, after 4 hours of ischemia, and after 1 hour of reperfusion. Flow cytometry was used to quantify LPA in peripheral blood. Separate ISR groups were treated with tirofiban, a platelet GPIIb/IIIa inhibitor, and fucoidan, a selectin adhesion molecule inhibitor, and analyzed for LPA. Leukocyte CD11b expression and reactive oxygen species production were also analyzed to note the role of polymorphonuclear neutrophilic (PMN) activation on LPA formation. After ISR, LPA levels in peripheral blood were twice as large as preischemic levels. Both GPIIb/IIIa and selectin adhesion molecule inhibition (p < .05) decreased LPA to preischemic values. PMN CD11b expression was increased above baseline but did not differ between groups. Reactive oxygen species production did not differ between groups during reperfusion. These data suggest that ischemic stroke and reperfusion results in an increase in LPA that can be consistently measured in peripheral blood. LPA formation may be a useful biomarker and potential therapeutic target after ischemic stroke and reperfusion.
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Affiliation(s)
- Leslie S Ritter
- University of Arizona, College of Nursing, Department of Neurology, Sarver Heart Center, PO Box 245023, Tucson, AZ 85724-5023, USA.
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Gül C, Kürüm T, Demir M, Ozbay G, Vural O, Iqbal O, Fareed J. Acute Myocardial Infarction in a Patient with Essential Thrombocythemia Treated with Glycoprotein Ilb/Illa Inhibitor. Clin Appl Thromb Hemost 2016; 10:77-9. [PMID: 14979411 DOI: 10.1177/107602960401000114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Essential thrombocythemia (ET) rarely causes obstruction of coronary arteries or acute myocardial infarction. Treatment of acute myocardial infarction in patients with ET may be a problem due to the important role of platelets in the pathogenesis of infarction. There is no reported case of acute myocardial infarction with essential thrombocythemia treated with a glycoprotein lIb/Illa inhibitor. In this report, a 49-year-old woman with essential thrombocythemia, admitted with a diagnosis of acute inferolateral myocardial infarction, was treated with tirofiban, a glycoprotein IIb/IIIa receptor blocker.
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Affiliation(s)
- Cetin Gül
- Department of Cardiology, Division of Hematology, Trakya University, Edirne, Turkey
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29
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Wei P, Huang YJ, Zuo XH, Zhang YG, Tao ZQ, Qiu CR, Zhang Q, Yang XJ, Fu Q. Clinical effects of treatment with Tirofiban on patients with high-risk NSTE-ACS after PCI. Eur Rev Med Pharmacol Sci 2016; 20:1356-1359. [PMID: 27097959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To explore clinical effects of Tirofiban treatment on patients with high-risk non-ST-segment elevation acute coronary syndrome (NSTE-ACS) after percutaneous coronary intervention (PCI). PATIENTS AND METHODS 107 patients with high-risk NSTE-ACS after PCI were selected and were divided into two groups. One group of 56 patients was treated with Tirofiban and a second group of 51 patients was taken as control. The occurrence conditions of creatine kinase-myoglobin (CK-MB), cardiac troponin1 (cTnI) level, hemorrhage incidents and major adverse cardiac events (MACE) incidents after treatments were compared. RESULTS After 24 h operation, CK-MB and cTnI level in Tirofiban group were both significantly lower than those in control group (p < 0.05), while the difference of hemorrhage incidents between two groups is of no statistical significance (p < 0.05); and the differences in overall occurrence rate of MACE incidents and the occurrence rate of angina pectoris after infarct between two groups were statistically significant (p < 0.05). CONCLUSIONS Tirofiban could improve the blood supply condition of hearts of patients with high-risk NSTE-ACS after emergent PCI, lower the occurrence rate of MACE incidents, and decrease the risk of hemorrhage.
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Affiliation(s)
- P Wei
- Department of Cardiology, Xuzhou Central Hospital, Xuzhou, China.
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Kim S, Choi JH, Kang M, Cha JK, Huh JT. Safety and Efficacy of Intravenous Tirofiban as Antiplatelet Premedication for Stent-Assisted Coiling in Acutely Ruptured Intracranial Aneurysms. AJNR Am J Neuroradiol 2016; 37:508-14. [PMID: 26471748 DOI: 10.3174/ajnr.a4551] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/13/2015] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Stent-assisted coiling of intracranial aneurysms requires antiplatelet therapy, typically aspirin and clopidogrel to prevent thromboembolic complications. There is a substantial concern that tirofiban may increase the risk of hemorrhage when used as an antiplatelet premedication in ruptured intracranial aneurysms. Our aim was to evaluate the safety and efficacy of intravenous tirofiban administration, instead of oral dual antiplatelet agents, as an antiplatelet premedication for stent-assisted coiling in patients with acutely ruptured intracranial aneurysms. MATERIALS AND METHODS We conducted a retrospective review of a data base containing a consecutive series of patients who underwent stent-assisted coiling for acutely ruptured intracranial aneurysms between March 2010 and January 2015. Intravenous tirofiban was administered to all patients before stent-assisted coiling, instead of premedication with loading doses of aspirin or clopidogrel. RESULTS Forty patients with 41 aneurysms received intravenous tirofiban and underwent stent-assisted coiling. None of the patients had a newly developed intracerebral hemorrhage, subarachnoid hemorrhage, or intraventricular hemorrhage. Intraprocedural aneurysmal rupture occurred in 2 patients (5%). Cerebral infarction developed in 2 patients (5%). Ventriculostomy-related hemorrhage was seen in 2 of 10 patients in whom ventriculostomy was performed before or after coiling. Thirty-four (85%) patients had a good outcome (Glasgow Outcome Score of 4 or 5) at the time of discharge, but 1 patient died of cardiac arrest. None of the patients developed thrombocytopenia, retroperitoneal, gastrointestinal, or genitourinary bleeding related to tirofiban administration. CONCLUSIONS In our study, tirofiban showed a low risk of symptomatic hemorrhagic or thromboembolic complications. Tirofiban may offer a safe and effective alternative as an antiplatelet premedication during stent-assisted coiling of acutely ruptured intracranial aneurysms.
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Affiliation(s)
- S Kim
- From the Departments of Radiology (S.K., M.K.)
| | | | - M Kang
- From the Departments of Radiology (S.K., M.K.)
| | - J-K Cha
- Neurology (J.-K.C.), Busan-Ulsan Regional Cardio-Cerebrovascular Disease Center, Dong-A University Hospital, Busan, Republic of Korea
| | - J-T Huh
- Neurosurgery (J.-H.C., J.-T.H.)
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Mansur ADP, Roggerio A, Takada JY, Caribé PMV, Avakian SD, Strunz CMC. Gene mutations of platelet glycoproteins and response to tirofiban in acute coronary syndrome. SAO PAULO MED J 2016; 134:199-204. [PMID: 26786608 PMCID: PMC10496600 DOI: 10.1590/1516-3180.2015.00650808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2015] [Revised: 03/26/2015] [Accepted: 08/08/2015] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVES Glycoprotein inhibitors (abciximab, eptifibatide and tirofiban) are used in patients with unstable angina and non-ST-segment elevation myocardial infarction before percutaneous coronary intervention. Of these, tirofiban is the least effective. We hypothesized that the response to tirofiban might be associated with glycoprotein gene mutations. DESIGN AND SETTING Prospective study at Emergency Unit, Heart Institute (InCor), University of São Paulo. METHOD Intrahospital evolution and platelet aggregation in response to tirofiban were analyzed in relation to four glycoprotein mutations in 50 patients indicated for percutaneous coronary intervention: 17 (34%) with unstable angina and 33 (66%) with non-ST-segment elevation myocardial infarction. Platelet aggregation was analyzed using the Born method. Blood samples were obtained before and one hour after tirofiban infusion. Glycoproteins Ia (807C/T ), Ib (Thr/Met) , IIb (Ile/Ser ) and IIIa (PIA ) were the mutations selected. RESULTS Hypertension, dyslipidemia, diabetes, smoking, previous coronary artery disease and stroke were similar between the groups. Mutant glycoprotein IIIa genotypes had lower platelet aggregation before tirofiban administration than that of the wild genotype (41.0% ± 22.1% versus 55.9% ± 20.8%; P = 0.035). Mutant glycoprotein IIIa genotypes correlated moderately with lower platelet inhibition (r = -0.31; P = 0.030). After tirofiban administration, platelet glycoprotein Ia, Ib, IIb and IIIa mutations did not influence the degree of inhibition of platelet aggregation or intrahospital mortality. CONCLUSIONS Mutations of glycoproteins Ia, Ib, IIb and IIIa did not influence platelet aggregation in response to tirofiban in patients with unstable angina and non-ST-segment elevation myocardial infarction.
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Affiliation(s)
- Antonio de Padua Mansur
- MD, PhD. Associate Professor, Department of Cardiopulmonology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Alessandra Roggerio
- BSc, PhD. Biochemist, Department of Cardiopulmonology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Júlio Yoshio Takada
- MD, PhD. Attending Physician, Department of Cardiopulmonology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Pérola Michelle Vasconcelos Caribé
- MD, MSc. Doctoral Student, Department of Cardiopulmonology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Solange Desirée Avakian
- MD, PhD. Attending Physician, Department of Cardiopulmonology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
| | - Célia Maria Cassaro Strunz
- BSc. Central Laboratory Director, Department of Cardiopulmonology, Instituto do Coração, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil.
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Serafimovska MD, Janevik-Ivanovska E, Ugresic M, Djorgoski I. Imaging of deep venous thrombosis using radioactive-labeled tirofiban. ACTA ACUST UNITED AC 2016; 116:621-6. [PMID: 26531874 DOI: 10.4149/bll_2015_120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The development of radiolabeled small peptide or peptidomimetic ligands can bind platelets and their specific expressed receptor have been suggested as a new approach to detect the clot location and, more essentially, to determine the age and morphology of the evolving thrombus. This new approach is focused on the use of a series of radiolabeled platelet GPIIb/IIIa receptor antagonists. Tirofiban N-(butylsulfonyl)- 4-O-(4-(4-piperidyl)-L-tyrosine is a non-peptide tyrosine derivate. The aim of the study was to introduce radioactive-labeled tirofiban as a specific imaging agent for acute DVT. The labeling was performed with technetium-99 in the presence of a stannous reducing agent. The labeled preparation showed fast blood clearance in a normal rat model (without induced thrombosis). More than 80% of the injected dose was eliminated from the circulation in the first hour after injection. Biodistribution and visualization of the labeled molecule was carried out using an experimental model of thrombosis in a male Wistar rat. Planar images were obtained 30 and 60 min after application of 2×10(6) imp/min 99m-technetium-tirofiban in the rat's tail vein. Sensitivity and specificity were determined using the ratio of 'left leg positive for DVT' to 'right leg negative for DVT'. The obtained ratio was 1.54 after 30 min and 5.04 after 60 min. These values were considered positive in the detection of acute DVT. The high DVT uptake shows that radiolabeled tirofiban in the introduced rat model can be a promising agent for imaging the deep venous thrombosis (Fig. 7, Ref. 25).
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Krishna K, Hiremath S, Lakade S, Davakhar S. Acute Myocardial Infarction in Nephrotic Syndrome. J Assoc Physicians India 2015; 63:67-68. [PMID: 29900715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A 28 year old male, known case of nephrotic syndrome since 12 years, hypertensive presented with acute myocardial infarction (AMI) and accelerated hypertension. Coronary angiography revealed 100% thrombotic occlusion of mid left anterior descending artery, treated with thrombus aspiration and intracoronary tirofiban and nitroglycerine. He was stabilized within 24 hours. The pathogenesis of AMI in nephrotic syndrome has been discussed with this case report.
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Li J, Yu S, Qian D, He Y, Jin J. Bivalirudin Anticoagulant Therapy With or Without Platelet Glycoprotein IIb/IIIa Inhibitors During Transcatheter Coronary Interventional Procedures: A Meta-Analysis. Medicine (Baltimore) 2015; 94:e1067. [PMID: 26266343 PMCID: PMC4616679 DOI: 10.1097/md.0000000000001067] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The safety and effectiveness of using the direct thrombin inhibitor bivalirudin during transcatheter coronary interventional procedures remains uncertain.This study aimed to systematically assess anticoagulation with bivalirudin alone or bivalirudin plus glycoprotein (GP) IIb/IIIa inhibitors (bivalirudin-based anticoagulant therapy) in patients undergoing percutaneous coronary intervention (PCI) procedures by a meta-analysis of randomized controlled trials (RCTs).Systematical searches of the MEDLINE, EMBASE, and Cochrane databases were conducted. RCTs comparing bivalirudin-based anticoagulant therapy with a comparable heparin therapy in patients undergoing PCI were eligible. Risk ratios (RRs) with 95% confidence intervals (CIs) served as summary statistics.A total of 38,096 patients from 17 RCTs were randomized to the bivalirudin group (n = 18,878) or heparin group (n = 19,218) in the meta-analysis. No significant differences in death, myocardial infarction or reinfarction, ischemia-driven revascularization, or in-stent thrombosis were observed between the 2 groups (all P > 0.05). Notably, bivalirudin-based therapy showed a highly significant 34% decrease in the incidence of major bleeding (RR = 0.66; 95% CI 0.54-0.81; P < 0.001) and a 28% reduction in the need for blood transfusion (RR = 0.72; 95% CI 0.56-0.91; P < 0.01). Meta-regression analyses demonstrated that additional administration of GP IIb/IIIa receptor inhibitors (P = 0.01), especially eptifibatide (P = 0.001) and tirofiban (P = 0.002), was likely to increase the major bleeding risk associated with bivalirudin.Bivalirudin, in comparison to heparin, is associated with a markedly lower risk of major bleeding, and the additional use of GP IIb/IIIa inhibitors may weaken this benefit.
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Affiliation(s)
- Jiabei Li
- From the Institute of Cardiovascular Science, Xinqiao Hospital, Third Military Medical University, Chongqing, China
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35
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Tang X, Li R, Jing Q, Liu Y, Liu P. Efficacy and Safety of Intracoronary versus Intravenous Administration of Tirofiban during Percutaneous Coronary Intervention for Acute Coronary Syndrome: A Meta-Analysis of Randomized Controlled Trials. PLoS One 2015; 10:e0129718. [PMID: 26067296 PMCID: PMC4465926 DOI: 10.1371/journal.pone.0129718] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 05/12/2015] [Indexed: 11/19/2022] Open
Abstract
Background Percutaneous coronary intervention (PCI) is known as the most effective treatment for acute coronary syndrome (ACS). However, without proper therapy and patient management, stent thrombosis after PCI may lead to another myocardial infarction. In addition to aspirin and clopidogrel, tirofiban is often used as an antiplatelet therapy in patients with ACS. To date, there has been no comprehensive evaluation of the efficacy and safety of intracoronary (IC) tirofiban administration for ACS patients undergoing PCI compared with intravenous (IV) administration. Therefore, this meta-analysis was conducted to investigate the clinical efficiency and safety of IC versus intravenous (IV) tirofiban in ACS patients undergoing PCI. Methods We searched PubMed and Medline for randomized controlled trials (RCTs) comparing IC versus IV administration of tirofiban in ACS patients undergoing PCI. We evaluated the effects of tirofiban on thrombolysis in myocardial infarction (TIMI) grade 3 flow after PCI, TIMI myocardial perfusion grade 3 (TMP grade 3), left ventricular ejection fraction (LVEF), major adverse cardiovascular events (MACE), target vessel revascularization (TVR), death, reinfarction and adverse drug effects (specifically bleeding events). Results Seven trials involving 1,027 patients were included in this meta-analysis. IC administration of tirofiban significantly increased TIMI grade 3 flow (OR 2.11; 95% CI 1.02 to 4.37; P = 0.04) and TMP grade 3 (OR 2.67; 95% CI 1.09 to 6.49; P = 0.03, I2 = 64%) while reducing MACE (OR 0.46, 95% CI: 0.28 to 0.75; P = 0.002) compared with IV administration of tirofiban. No significant differences were observed in the occurrence of TVR, death, reinfarction and the incidence of bleeding events between the two groups. Conclusions This meta-analysis supports the use of IC over IV administration of tirofiban in patients with ACS to improve TIMI flow, TMP flow and MACE. However, there was no statistically significant difference in the risk of bleeding complications between the two groups.
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Affiliation(s)
- Xiuying Tang
- Department of Cardiology, The first hospital of QinHuangDao, QinHuangDao, HeBei, China
- * E-mail:
| | - Runjun Li
- Department of Emergency Medicine, The first hospital of QinHuangDao, QinHuangDao, HeBei, China
| | - Quanmin Jing
- Department of Cardiology, General Hospital of Shenyang Military Area Command, Shenyang, LiaoNing, China
| | - Yingfeng Liu
- Department of Cardiology, Zhujiang hospital, Southern Medical University, GuangZhou, GuangDong, China
| | - Peng Liu
- Department of Cardiology, Zhujiang hospital, Southern Medical University, GuangZhou, GuangDong, China
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Guan W, Wang Z, Liu Y, Han Y, Ren H, Eric Wang W, Yang J, Zhou L, Zeng C. Protective effects of tirofiban on ischemia/reperfusion-induced renal injury in vivo and in vitro. Eur J Pharmacol 2015; 761:144-52. [PMID: 25981297 DOI: 10.1016/j.ejphar.2015.05.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 05/07/2015] [Accepted: 05/13/2015] [Indexed: 01/01/2023]
Abstract
Tirofiban, a glycoprotein IIb/IIIa receptor inhibitor, is widely used in the management of patients with unstable angina or myocardial infarction, and shows protective effects on ischemia/reperfusion (I/R) injured heart. Whether or not it has protective effect on I/R injured kidney is not known. The present in vivo and in vitro study found that serum creatinine (SCR) and blood urea nitrogen (BUN) were significantly increased in I/R rats, accompanied by histopathological damage of the kidney. Apoptotic cells, leukocyte infiltration and ROS production were increased in I/R rats. Pretreatment by intravenous injection of tirofiban (200μg/kg) reduced SCR and BUN levels, ameliorated renal histopathological changes, and decreased ROS production, cell apoptosis and leukocyte infiltration in I/R injured kidney. Our further study showed that the protection of tirofiban might be associated with the restoration of eNOS/iNOS balance, since inhibition of NO production blocked the tirofiban-mediated renal protection on I/R injury. The present in vivo and in vitro study indicated that tirofiban pretreatment exerts a protective effect on I/R injury in kidney through regulation of eNOS/iNOS balance.
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Affiliation(s)
- Weiwei Guan
- Department of Cardiology, Daping Hospital, The Third Military Medical University, 400042 Chongqing, China; Chongqing Institute of Cardiology, 400042 Chongqing, China
| | - Zhen Wang
- Department of Cardiology, Daping Hospital, The Third Military Medical University, 400042 Chongqing, China; Chongqing Institute of Cardiology, 400042 Chongqing, China
| | - Yukai Liu
- Department of Cardiology, Daping Hospital, The Third Military Medical University, 400042 Chongqing, China; Chongqing Institute of Cardiology, 400042 Chongqing, China
| | - Yu Han
- Department of Cardiology, Daping Hospital, The Third Military Medical University, 400042 Chongqing, China; Chongqing Institute of Cardiology, 400042 Chongqing, China
| | - Hongmei Ren
- Department of Cardiology, Daping Hospital, The Third Military Medical University, 400042 Chongqing, China; Chongqing Institute of Cardiology, 400042 Chongqing, China
| | - Wei Eric Wang
- Department of Cardiology, Daping Hospital, The Third Military Medical University, 400042 Chongqing, China; Chongqing Institute of Cardiology, 400042 Chongqing, China
| | - Jian Yang
- Department of Cardiology, Daping Hospital, The Third Military Medical University, 400042 Chongqing, China; Chongqing Institute of Cardiology, 400042 Chongqing, China.
| | - Lin Zhou
- Department of Cardiology, Daping Hospital, The Third Military Medical University, 400042 Chongqing, China; Chongqing Institute of Cardiology, 400042 Chongqing, China.
| | - Chunyu Zeng
- Department of Cardiology, Daping Hospital, The Third Military Medical University, 400042 Chongqing, China; Chongqing Institute of Cardiology, 400042 Chongqing, China.
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Affiliation(s)
- Matthew A Cavender
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - David P Faxon
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Han Y, Guo J, Zheng Y, Zang H, Su X, Wang Y, Chen S, Jiang T, Yang P, Chen J, Jiang D, Jing Q, Liang Z, Liu H, Zhao X, Li J, Li Y, Xu B, Stone GW. Bivalirudin vs heparin with or without tirofiban during primary percutaneous coronary intervention in acute myocardial infarction: the BRIGHT randomized clinical trial. JAMA 2015; 313:1336-46. [PMID: 25775052 DOI: 10.1001/jama.2015.2323] [Citation(s) in RCA: 219] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
IMPORTANCE The safety and efficacy of bivalirudin compared with heparin with or without glycoprotein IIb/IIIa inhibitors in patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI) are uncertain. OBJECTIVE To determine if bivalirudin is superior to heparin alone and to heparin plus tirofiban during primary PCI. DESIGN, SETTING, AND PARTICIPANTS Multicenter, open-label trial involving 2194 patients with AMI undergoing primary PCI at 82 centers in China between August 2012 and June 2013. INTERVENTIONS Patients were randomly assigned to receive bivalirudin with a post-PCI infusion (n = 735), heparin alone (n = 729), or heparin plus tirofiban with a post-PCI infusion (n = 730). Among patients treated with bivalirudin, a postprocedure 1.75 mg/kg/h infusion was administered for a median of 180 minutes (IQR, 148-240 minutes). MAIN OUTCOMES AND MEASURES The primary end point was 30-day net adverse clinical events, a composite of major adverse cardiac or cerebral events (all-cause death, reinfarction, ischemia-driven target vessel revascularization, or stroke) or bleeding. Additional prespecified safety end points included the rates of acquired thrombocytopenia at 30 days, and stent thrombosis at 30 days and 1 year. RESULTS Net adverse clinical events at 30 days occurred in 65 patients (8.8%) of 735 who were treated with bivalirudin compared with 96 patients (13.2%) of 729 treated with heparin (relative risk [RR], 0.67; 95% CI, 0.50-0.90; difference, -4.3%, 95% CI, -7.5% to -1.1%; P = .008); and 124 patients (17.0%) of 730 treated with heparin plus tirofiban (RR for bivalirudin vs heparin plus tirofiban, 0.52; 95% CI, 0.39-0.69; difference, -8.1%, 95% CI, -11.6% to -4.7%; P < .001). The 30-day bleeding rate was 4.1% for bivalirudin, 7.5% for heparin, and 12.3% for heparin plus tirofiban (P < .001). There were no statistically significant differences between treatments in the 30-day rates of major adverse cardiac or cerebral events (5.0% for bivalirudin, 5.8% for heparin, and 4.9% for heparin plus tirofiban, P = .74), stent thrombosis (0.6% vs 0.9% vs 0.7%, respectively, P = .77), acquired thrombocytopenia (0.1% vs 0.7% vs 1.1%; P = .07), or in acute (<24-hour) stent thrombosis (0.3% in each group). At the 1-year follow-up, the results remained similar. CONCLUSIONS AND RELEVANCE Among patients with AMI undergoing primary PCI, the use of bivalirudin with a median 3-hour postprocedure PCI-dose infusion resulted in a decrease in net adverse clinical events compared with both heparin alone and heparin plus tirofiban. This finding was primarily due to a reduction in bleeding events with bivalirudin, without significant differences in major adverse cardiac or cerebral events or stent thrombosis. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01696110.
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Affiliation(s)
- Yaling Han
- General Hospital of Shenyang Military Region, Shenyang, Liaoning Province, China
| | - Jincheng Guo
- Luhe Hospital, Capital Medical University, Beijing, China
| | - Yang Zheng
- The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Hongyun Zang
- No. 463 Hospital of PLA, Shenyang, Liaoning Province, China
| | - Xi Su
- Wuhan Asia Heart Hospital, Wuhan, Hubei Province, China
| | - Yu Wang
- General Hospital of People's Liberation Army, Beijing, China
| | - Shaoliang Chen
- Nanjing First Hospital, Nanjing, Jiangsu Province, China
| | - Tiemin Jiang
- Affiliated Hospital of Logistics University of CAPF, Tianjin, China
| | - Ping Yang
- The Third Hospital of Jilin University, Changchun, Jilin Province, China
| | - Jiyan Chen
- Guangdong General Hospital, Guangdong Province, China
| | - Dongju Jiang
- No. 210 Hospital of PLA, Dalian, Liaoning Province, China
| | - Quanmin Jing
- General Hospital of Shenyang Military Region, Shenyang, Liaoning Province, China
| | - Zhenyang Liang
- General Hospital of Shenyang Military Region, Shenyang, Liaoning Province, China
| | - Haiwei Liu
- General Hospital of Shenyang Military Region, Shenyang, Liaoning Province, China
| | - Xin Zhao
- General Hospital of Shenyang Military Region, Shenyang, Liaoning Province, China
| | - Jing Li
- General Hospital of Shenyang Military Region, Shenyang, Liaoning Province, China
| | - Yi Li
- General Hospital of Shenyang Military Region, Shenyang, Liaoning Province, China
| | - Bo Xu
- Fu Wai Hospital, National Center for Cardiovascular Diseases, Beijing, China
| | - Gregg W Stone
- Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
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Barbieri L, Verdoia M, Schaffer A, Marino P, De Luca G. [Two catheters for one coronary perforation]. G Ital Cardiol (Rome) 2015; 16:112-5. [PMID: 25805096 DOI: 10.1714/1798.19588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Coronary perforation is a severe complication of percutaneous coronary intervention (PCI) with high mortality and morbidity. The incidence of coronary perforation in patients undergoing PCI ranges from 0.1% to 0.5%. The use of long balloon inflation and reversal anticoagulation is associated with high mortality, periprocedural myocardial infarction and emergency coronary bypass surgery. We present a case of severe coronary perforation treated with the dual catheter technique through the radial and femoral approach. The dual catheter technique enabled rapid delivery of a covered stent without losing control of the perforation site. Our patient did not show pericardial effusion, hemodynamic instability or need for emergency bypass surgery. About 1h after PCI, he developed acute stent thrombosis treated with thromboaspiration and biolimus-eluting stent implantation. At 2 years of follow-up, he was asymptomatic without evidence of exercise-induced ischemia. We conclude that the dual catheter technique is a safe and effective approach to treat PCI-induced severe coronary perforation, and may significantly improve patient outcome compared to historical series.
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Natarajan D. Acute thrombosis during left main stenting using tap technique in a patient presenting with non-ST-segment elevation acute coronary syndrome. Cardiovasc Revasc Med 2014; 16:249-53. [PMID: 25537732 DOI: 10.1016/j.carrev.2014.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 11/21/2014] [Indexed: 11/29/2022]
Abstract
This case reports the sudden development of large burden of thrombi in the left anterior descending coronary artery immediately following distal left main stenting using TAP technique in a middle aged man who presented with non ST-segment elevation acute coronary syndrome despite having been administered 7,500 units of unfractionated heparin and being given 325 mg of aspirin and 60 mg of prasugrel prior to the procedure. The thrombi were managed effectively by giving an intra-coronary high bolus dose of tirofiban (25 mcg/kg) without the need for catheter thrombus extraction. Tirofiban intra-venous infusion was maintained for 18 hours, and the patient was discharged in stable condition on the third day. Importantly there is no controlled study on upstream administration of glycoprotein IIb/IIIa inhibitors in addition to the newer more potent anti-platelet agents in patients with unprotected distal left main disease presenting with non ST-segment elevation acute coronary syndrome, nor is there any data on safety and efficacy of mandatory usage of injectable anti-platelet agents at the start of a procedure in a catheterization laboratory in such a setting.
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Faruk Akturk I, Arif Yalcin A, Biyik I, Sarikamis C, Turhan Caglar N, Erturk M, Celik O, Uzun F, Murat Caglar I, Oner E. Effects of verapamil and adenosine in an adjunct to tirofiban on resolution and prognosis of noreflow phenomenon in patients with acute myocardial infarction. Minerva Cardioangiol 2014; 62:389-397. [PMID: 24699550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM We aimed to investigate the effects of verapamil and adenosine in an adjunct to intravenous tirofiban on management and prognosis of no-reflow phenomenon during primary percutaneous coronary intervention (PPCI) and to compare their efficacies on reversing of no-reflow phenomenon and short and midterm survival. METHODS We included 46 patients with acute ST-segment elevation myocardial infarction (STEMI) and occurrence of no-reflow phenomenon after PPCI. All patients received intravenous tirofiban and then randomized into one of the following 3 groups: intracoronary adenosine (N.=16), intracoronary verapamil (N.=15) or placebo (N.=15). RESULTS Intracoronary verapamil therapy had significant effect in restoring impaired coronary blood flow by decreasing thrombolysis in myocardial infarction (TIMI) frame count from 73±44 to 52±48 (P=0.024). However, adenosine and serum physiologic administration were not found to be so effective in decreasing TIMI frame count (from 81±35 to 71±46, P=0.084; from 74±32 to 71±37, P=0.612, respectively). In-hospital and 6-month survival rates were similar among groups. CONCLUSION In conclusion, intracoronary verapamil restored the impaired coronary blood flow more effectively than adenosine or placebo. However, none of them has changed the clinical course in the first 6 months.
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Affiliation(s)
- I Faruk Akturk
- Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey -
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Swoboda S, Walter T, Lang S, Wendel HP, Beyer ME, Griesel E, Hoffmeister HM, Gruettner J. Effect of GPIIb/IIIa inhibition with eptifibatide or tirofiban on the expression of cellular adhesion molecules on monocytes. In Vivo 2014; 28:691-697. [PMID: 25189879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
AIM The aim of the present study was to investigate the effect of GPIIb/IIIa inhibition with eptifibatide and tirofiban on the expression of cellular adhesion molecules on monocytes at different temperatures. MATERIALS AND METHODS Circulation of blood from six volunteers was performed in an extracorporal circulation model at 36°C and 18°C for 30 min. The blood of each donor was prepared either with addition of eptifibatide or tirofiban, or was left untreated as control. CD54 and CD162 on monocytes was measured using flow cytometry. RESULTS Expression of CD11b was lower at 18°C compared to 36°C by 51% in the eptifibatide group (p=0.0043), by 29% in the tirofiban group (p=0.095) and by 34% in the control group (p=0.038). Expression of CD54 was not significantly different at 18°C compared to 36°C, neither with eptifibatide (p=0.29) nor tirofiban (p=0.48) nor in the control group (p=0.26). Expression of CD162 was lower at 18°C compared to 36°C by 40% using eptifibatide (p=0.0010), by 94% using tirofiban (p=0.0095) and by 34% in the control group (p=0.019). At 36°C and 18°C, no significant differences were found regarding the expression of CD11b, CD54 and CD162 between the eptifibatide-treated group, the tirofiban-treated group and the control group. CONCLUSION GPIIb/IIIa inhibition with eptifibatide or tirofiban seems to have no effect on the expression of CD11b, CD54 and CD162 on monocytes during normothermia or hypothermia. Our results show that the beneficial effect induced by hypothermia on the extracorporal circulation-associated alteration of leukocyte function, with decreased expression of CD11b and CD162, seems not to be affected by additional treatment with eptifibatide or tirofiban.
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Affiliation(s)
- Stefanie Swoboda
- Pharmacy Department of the University Hospital of Heidelberg, Heidelberg, Germany
| | - Thomas Walter
- Emergency Department, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Siegfried Lang
- First Department of Medicine (Cardiology), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Hans-Peter Wendel
- Clinic for Thoracic, Cardiac and Vascular Surgery, University of Tuebingen, Tuebingen, Germany
| | - Martin E Beyer
- Department of Internal Medicine II, Kirchheim Hospital, Kirchheim, Germany
| | - Eva Griesel
- Department of Internal Medicine II, Kirchheim Hospital, Kirchheim, Germany
| | | | - Joachim Gruettner
- Emergency Department, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
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Zhang Y, Gao C, Li M, Liu H, Wang X, Yang H, Wang X, Zhu Z, Hu D. [Short- or long-outcome of early tirofiban in ST-segment elevated acute myocardial infarction undergoing elective percutaneous coronary intervention]. Zhonghua Nei Ke Za Zhi 2014; 53:273-277. [PMID: 24857299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To explore the optimal timing of tirofiban early treatment in ST-segment elevated acute myocardial infarction (STEMI) undergoing elective percutaneous coronary intervention (PCI). METHODS A total of 118 consecutive STEMI patients were enrolled in the study. They were randomly assigned to the tirofiban early treatment group with tirofiban administrated routinely at ≥ 4 hours prior to angiography or the control group with tirofiban provisional administrated during or after angiography. Thrombolysis in myocardial infarction (TIMI) flow, creatine kinase MB isoenzyme (CK-MB) levels, acute thrombus events, efficacy and safety endpoints at Day 7, Day 30, 6 months and 1 year (efficacy endpoints: death, myocardial infarction, target vessel revascularization and ischemic stroke; safety endpoints: bleeding and thrombocytopenia) were observed and compared between the two groups. RESULTS A total of 104 STEMI patients underwent elective PCI with 52 patients in each group and the baseline characteristics were balanced between the two groups. Tirofiban was administered (5.9 ± 2.9) hours earlier in the tirofiban early treatment group than the control group. No statistical difference was observed between the two groups in TIMI flow before[grade 0: 18 (34.6%) vs 19 (36.5%) , grade 3: 28 (53.8%) vs 27 (51.9%)] and after PCI[grade 3: 52 (100.0%) vs 51 (98.1%)]. No difference was shown between the two groups in CK-MB levels before PCI [(12.9 ± 5.1) U/L vs (12.0 ± 5.2) U/L, P > 0.05]; and the increase of CK-MB 12-24 hours after PCI [(1.0 ± 6.2) U/L vs (2.3 ± 8.3) U/L, P > 0.05]. The incidence of acute thrombus events was similar (7.7% vs 15.4%, P > 0.05). No statistical difference was observed between the two groups in the efficacy endpoints at Day 7 (0.0% vs 7.7%, P > 0.05), Day 30 (0.0% vs 7.8%, P > 0.05), 6 months (2.0% vs 9.8%, P > 0.05) and 1 year (2.2% vs 9.8%, P > 0.05). Similar incidence was shown in the slight bleeding (15.4% vs 5.8%, P > 0.05) and the slight thrombocytopenia (0.0% vs 1.9%, P > 0.05), while no severe to moderate bleeding or severe thrombocytopenia happened in both groups. CONCLUSION Tirofiban early treatment is not better than the tirofiban bailout treatment during or after PCI in STEMI patients undergoing elective PCI. Trail registration ChiCTR-TRC-10000809.
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Affiliation(s)
| | - Chuanyu Gao
- Department of Cardiology, Zhengzhou University People's Hospital, Henan Institute of Cardiovascular Epidemiology, Zhengzhou 450003, China.
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Abstract
BACKGROUND Glycoprotein (GP) IIb-IIIa inhibitors are antiplatelet agents that act by antagonising GP IIb-IIIa receptors on the platelet surface and block the final common pathway to platelet aggregation by preventing the binding of fibrinogen molecules that form bridges between adjacent platelets. Thus, GP IIb-IIIa inhibitors could favour endogenous thrombolysis by reducing thrombus growth and preventing thrombus re-formation through competitive inhibition with fibrinogen and, due to their mechanism of action, are likely to have a more profound antiplatelet effect with more rapid onset than conventional antiplatelet agents, such as aspirin or clopidogrel. Currently used in clinical practice for the treatment of individuals with acute coronary syndromes and during coronary angioplasty, GP IIb-IIIa inhibitors could also be useful for the treatment of people with acute ischaemic stroke. OBJECTIVES To assess the use of GP IIb-IIIa inhibitors in people with acute ischaemic stroke to evaluate whether such treatments (1) reduce the proportion of patients who die or remain dependent, and (2) are sufficiently safe for general use. We wished to examine the effects GP IIb-IIIa inhibitors alone or in combination with thrombolytic agents. SEARCH METHODS We searched the Cochrane Stroke Group trials register (last searched 10 June 2013), MEDLINE (1966 to June 2013), EMBASE (1980 to June 2013), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 5, 2013), and major ongoing clinical trials registers (June 2013). We also searched reference lists and contacted trial authors and pharmaceutical companies. SELECTION CRITERIA We aimed to analyse unconfounded randomised controlled trials (RCTs) of GP IIb-IIIa inhibitors in the treatment of people with acute ischaemic stroke. Only individuals who started treatment within six hours of stroke onset were included. DATA COLLECTION AND ANALYSIS We independently selected trials for inclusion, assessed trial quality and extracted the data. MAIN RESULTS We included four trials involving 1365 participants. Three trials compared the intravenous GP IIb-IIIa inhibitor Abciximab with intravenous placebo (1215 participants) and one trial compared the intravenous GP IIb-IIIa inhibitor Tirofiban with intravenous aspirin (150 participants). Treatment with either of these GP IIb-IIIa inhibitors did not significantly reduce long-term death or dependency (odds ratio (OR) 0.97, 95% confidence interval (CI) 0.77 to 1.22, for the comparison between Abciximab and placebo; OR 1.00, 95% CI 0.52 to 1.92, for the comparison between Tirofiban and aspirin) and had no effect on deaths from all causes (OR 1.08, 95% CI 0.77 to 1.53, for the comparison between Abciximab and placebo; OR 1.00, 95% CI 0.35 to 2.82, for the comparison between Tirofiban and aspirin). Abciximab was associated with a significant increase in symptomatic intracranial haemorrhage (OR 4.6, 95% CI 2.01 to 10.54) and with a non-significant increase in major extracranial haemorrhage (OR 1.81, 95% CI 0.96 to 3.41), whereas the only small trial comparing Tirofiban with aspirin showed no increased risk of bleeding complications with Tirofiban (OR 0.32, 95% CI 0.03 to 3.19, for symptomatic intracranial haemorrhage; OR 3.04, 95% CI 0.12 to 75.83, for major extracranial haemorrhages). There was no significant inconsistency across the studies. AUTHORS' CONCLUSIONS The available trial evidence showed that, for individuals with acute ischaemic stroke, GP IIb-IIIa inhibitors are associated with a significant risk of intracranial haemorrhage with no evidence of any reduction in death or disability in survivors. These data do not support their routine use in clinical practice. The conclusion is driven by trials of Abciximab, which contributed 89% of the total number of study participants considered.
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Affiliation(s)
- Alfonso Ciccone
- Department of Neurology and Stroke Unit, "Carlo Poma" Hospital, Strada Lago Paiolo 10, Mantua, Italy, 46100
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Zhang D, Wang L, Wang H, Xu L, Li W, Ni Z, Xia K, Liu Y, Yang X. [The effects of tirofiban on acute non-ST segment elevation myocardial infarction patients not receiving early reperfusion intervention]. Zhonghua Nei Ke Za Zhi 2014; 53:193-197. [PMID: 24767206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To study the efficacy and safety of tirofiban in patients with acute non-ST- segment elevation myocardial infarction (NSTEMI) without early reperfusion intervention. METHODS A total of 151 NSTEMI patients without early reperfusion intervention were enrolled in the study and randomized to the tirofiban group (n = 76) and the control group(n = 75). Coronary angiography was performed at day 3 and day 7, while percutaneous coronary intervention (PCI) was performed when necessary. Parameters including thrombolysis in myocardial infarction (TIMI) flow, bleeding complications and clinic events within 30 days were compared between the two groups. RESULTS Before PCI, no increase in the percentage of patient with TIMI flow better than TIMI-2 was observed by the treatment of tirofiban (69.3% vs 78.9%, P = 0.10). While after PCI, significant increase in the percentage of patient with TIMI flow better than TIMI-2 was manifested in the tirofiban group (96.0% vs 100.0%, P = 0.04). Tirofiban treatment also significantly decreased the rate of poor myocardial perfusion after PCI (19.7% vs 34.7%, P = 0.04). There were 0 and 4 major adverse cardiovascular events (MACE) within 30 days observed in the tirofiban group and the control group (0.0% vs 5.3%, P = 0.05). No difference between the two groups was found in the bleeding complications within 30 days including the mild hemorrhage (5 vs 4 cases, P = 0.75), severe hemorrhage (2 vs 1 cases, P = 0.56) or severe thrombocytopenia (2 vs 0 cases, P = 0.49). CONCLUSIONS Tirofiban treatment does not increase the bleeding complications in NSTEMI patients without early PCI. Tirofiban can improve the TIMI flow and the myocardial perfusion after PCI with less MACE within 30 days.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Xinchun Yang
- Heart Center, Beijing Chaoyang Hospital Affiliated to Capital Medical University, Beijing 100020, China.
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Karabay KO, Yildiz O, Aytekin V. Multiple coronary thrombi with cisplatin. J Invasive Cardiol 2014; 26:E18-E20. [PMID: 24486672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Testicular cancer is the most common malignancy in young men (15-29 years old). Combination therapy with bleomycin, etoposide, and cisplatin has been the standard first-line treatment for testicular metastatic disease. We present a case of multicoronary thrombi causing acute inferior myocardial infarction in a patient who recently received chemotherapy for testicular tumor.
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Affiliation(s)
- Kanber Ocal Karabay
- Department of Cardiology, Istanbul Bilim University, Buyukdere Cad. No:120, 34394 Esentepe Sisli/Istanbul.
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Abstract
Acute coronary syndromes represent a major health problem in terms of incidence and mortality. Intracoronary platelet-rich thrombi may develop in response to plaque rupture, and are involved in the pathogenesis of all acute coronary syndromes. The glycoprotein IIb/IIIa receptor, a platelet surface integrin, plays a key role in platelet aggregation once it has been activated by specific ligands. The development of glycoprotein IIb/IIIa inhibitors has revolutionized the management of acute coronary syndromes. Tirofiban is one of three parenteral glycoprotein IIb/IIIa inhibitors in clinical use, and many trials have demonstrated its clinical efficacy and low rate of adverse effects in patients with non-ST-segment elevation acute coronary syndrome. This article reviews the data concerning its use in the clinical settings of acute coronary syndromes and percutaneous coronary angioplasty, and discusses its benefits in different treatment strategies and in association with other drugs. In particular, the role of early, upstream tirofiban coupled with early aggressive revascularization in the management of high-risk non-ST-segment elevation acute coronary syndromes is emphasized.
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Affiliation(s)
- Alberto Menozzi
- Division of Cardiology, Maggiore Hospital, University of Parma, Parma, Italy.
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Liu Y, Su Q, Li L. Safety and efficacy of early administration of tirofiban in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: a meta-analysis. Chin Med J (Engl) 2014; 127:1126-1132. [PMID: 24622446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Tirofiban has been widely used as an adjunctive pharmacologic agent for revascularization in patients undergoing percutaneous coronary intervention, and the outcomes appear attractive. However, the potential benefits from early administration of tirofiban in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) remain unclear. METHODS We conducted a search in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials up to September 2012 without language restriction. A total of eight randomized trials (n = 1 577 patients) comparing early (emergency department or ambulance) versus late (catheterization laboratory) administration of tirofiban in STEMI patients undergoing PPCI were included in this meta-analysis. Risk ratio (RR) was computed from individual studies and pooled with random- or fixed-effect models. RESULTS There were no differences in post-procedural Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 and Corrected TIMI Frame Count (RR = 1.02, 95% confidence interval (CI): 0.99-1.05, P = 0.18; weighted mean difference (WMD) = -0.93, 95% CI: -5.37-3.52, P = 0.68, respectively) between the two groups. Similarly, there were no significant differences in the incidence of 30-day mortality (RR = 1.69, 95% CI: 0.69-4.13, P = 0.25) and re-myocardial infarction (RR = 0.71, 95% CI: 0.21-2.35, P = 0.57) between early and late administration of tirofiban. As to the safety end points, no significant difference was observed in hospital minor bleeding (RR = 1.08, 95% CI: 0.54-2.14, P = 0.83) and hospital and 30-day major bleeding between the two groups (RR = 0.98, 95% CI: 0.46-2.10, P = 0.96; RR = 1.32, 95% CI: 0.59-2.97, P = 0.49, respectively). CONCLUSIONS Early administration of tirofiban in patients undergoing PPCI for STEMI was safe, but no beneficial effects on post-procedural angiographic or clinical outcomes could be identified as compared with late administration. Besides the negative finding, more high-quality randomized clinical trials are still needed to explore the efficacy of adequate, earlier administration of tirofiban in patients undergoing PPCI.
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Affiliation(s)
- Yangchun Liu
- Department of Cardiology, First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, Guangxi 530021, China
| | - Qiang Su
- Department of Cardiology, First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, Guangxi 530021, China
| | - Lang Li
- Department of Cardiology, First Affiliated Hospital of Guangxi Medical University, Guangxi Cardiovascular Institute, Nanning, Guangxi 530021, China.
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Wang HL, Xing SY, Dong PS, Han YH, Zhu JH, Lai LH, Zhao JF. Safety and efficacy of intracoronary tirofiban administration in patients with serious thrombus burden and ST-elevation myocardial infarction undergoing percutaneous coronary intervention. Eur Rev Med Pharmacol Sci 2014; 18:3690-3695. [PMID: 25535142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE This work aims to explore the safety and efficacy of intracoronary tirofiban administration in patients with serious thrombus burden and ST-elevation myocardial infarction (STEMI) undergoing emergency percutaneous coronary intervention (PCI). PATIENTS AND METHODS A total of 104 patients with serious thrombus burden and acute STEMI were randomly divided into treatment (intracoronary tirofiban administration, 56 cases) and control (48 cases) groups. Comparison of coronary blood flow, ST-segment resolution (STR), duration of hospital stay, 30-day major adverse cardiac events (MACE) and complications such as hemorrhage was conducted. RESULTS In treatment group, the percentage of thrombolysis in myocardial infarction-3 (TIMI-3) flow in the infarct-related artery (IRA) increased (89.3% to 85.4, p < 0.05), blood flow in the IRA calculated with TIMI frame count method enhanced [(1.68 ± 0.23) ml/s to (1.42 ± 0.31) ml/s, p < 0.05], STR on electrocardiogram (ECG) enlarged [(64.3 ± 7.84)% to (48.6 ± 6.47)%, p < 0.05)] and the prevalence of MACE decreased (10.7% to 18.8%, p < 0.05), all of which were significantly different from those of control group, but no statistical difference in complications was observed between two groups (p > 0.05). CONCLUSIONS It was simple, safe and effective to perform intracoronary tirofiban administration in patients with serious thrombus burden and STEMI when undergoing emergency PCI.
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Affiliation(s)
- H-L Wang
- Department of Cardiology, the First Affiliated Hospital of Henan University of Science and Technology, Luoyang, China.
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Zhang D, Wang L, Du J, Wang H, Xu L, Li W, Ni Z, Xia K, Liu Y, Yang X. [Effect of intracoronary tirofiban combined with nitroprusside injection through thrombus aspiration catheter during primary percutaneous coronary intervention on acute anterior myocardial infarction patients with heavy thrombosis burden]. Zhonghua Xin Xue Guan Bing Za Zhi 2014; 42:25-30. [PMID: 24680265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To explore the impact of intracoronary bolus administration of tirofiban combined with nitroprusside through thrombus aspiration catheter or thrombus aspiration alone on myocardial reperfusion and major adverse cardiovascular events rate in acute anterior myocardial infarction patients with heavy thrombosis burden. METHODS Ninety consecutive acute anterior myocardial infarction patients with heavy thrombosis burden [(59.8 ± 11.5) years old] were randomly assigned to thrombus aspiration group (Group A, n = 30), thrombus aspiration and intracoronary tirofiban bolus (25 µg/kg prior to the first balloon inflation,Group B, n = 30), thrombus aspiration and intracoronary tirofiban combined with nitroprusside bolus (200 µg prior to the first balloon inflation, Group C, n = 30) with random number table. Baseline clinical data, angiographic features before and after percutaneous coronary intervention (PCI) and major adverse cardiovascular events after PCI between 3 groups were compared. RESULTS The baseline clinical data and angiographic features among 3 groups were similar (all P > 0.05) . The time of pain to balloon was (5.5 ± 3.8) hours. After primary PCI, myocardial tissue perfusion was significantly better in Group C than in Group A and Group B: TMP grade < 3 [10.0% (3/30) vs. 40.0% (12/30) and 33.3% (10/30), P < 0.01 and P < 0.05]. Left ventricular ejection fraction at 5 to 7 days after PCI also tended higher in Group C than in the other 2 groups (P = 0.05). One patient died of heart failure at 7th day after PCI in Group A, and no patient died in Group B and C. Thirty days after PCI, there was no re-myocardial infarction and target vessel revascularization event among 3 groups. The bleeding complication rate during 30 days follow-up was similar among 3 groups (P > 0.05) . CONCLUSION Intracoronary bolus application of tirofiban combined with nitroprusside through thrombus aspiration catheter after thrombus aspiration is associated with an improvement of myocardial reperfusion without increasing bleeding complication and other adverse cardiovascular events rate compared with thrombus aspiration alone in patients with acute anterior myocardial infarction and heavy thrombosis burden undergoing primary PCI.
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Affiliation(s)
- Dapeng Zhang
- Heart Center, Beijing Chaoyang Hospital affiliated to Capital Medical University,Beijing 100020, China
| | - Lefeng Wang
- Heart Center, Beijing Chaoyang Hospital affiliated to Capital Medical University,Beijing 100020, China.
| | - Jinquan Du
- Heart Center, Beijing Chaoyang Hospital affiliated to Capital Medical University,Beijing 100020, China
| | - Hongshi Wang
- Heart Center, Beijing Chaoyang Hospital affiliated to Capital Medical University,Beijing 100020, China
| | - Li Xu
- Heart Center, Beijing Chaoyang Hospital affiliated to Capital Medical University,Beijing 100020, China
| | - Weiming Li
- Heart Center, Beijing Chaoyang Hospital affiliated to Capital Medical University,Beijing 100020, China
| | - Zhuhua Ni
- Heart Center, Beijing Chaoyang Hospital affiliated to Capital Medical University,Beijing 100020, China
| | - Kun Xia
- Heart Center, Beijing Chaoyang Hospital affiliated to Capital Medical University,Beijing 100020, China
| | - Yu Liu
- Heart Center, Beijing Chaoyang Hospital affiliated to Capital Medical University,Beijing 100020, China
| | - Xinchun Yang
- Heart Center, Beijing Chaoyang Hospital affiliated to Capital Medical University,Beijing 100020, China
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