Perfil epidemiologico y valoraciones de enfermeria en pacientes con infarto agudo de miocardio tratados con inhibidores de glicoproteina IIB IIIA en Sanatorio Allende / Epidemiological profile and nursing assessments in patients with acute myocardial infartation treated with glicoprotein inhibitors IIB in IIIA

El infarto agudo de miocardio (IAM) representa la tercera causa de morbimortalidad en el país. Tener datos sobre la realidad de esta entidad en la institución es de suma importancia como punto de partida para el desarrollo de políticas de prevención, así también mejorar el tratamiento, cuidado y calidad de atención al paciente. OBJETIVO: Determinar el perfil epidemiológico de la población que se les indica tratamiento con Tirofiban durante infarto agudo de miocardio (IAM)...

Acutemyocardialinfarction (AMI) represents the third cause ofmorbidity and mortality in the country. Having information about the reality of this entity in the institution is of the utmost importance as a starting point for the development of prevention policies, as well as improving the treatment, care and quality of patientcare. OBJECTIVE: To determine the epidemiological profile of the population that is being treated with Tirofiban during acute myocardialinfarction (AMI)...

Gene mutations of platelet glycoproteins and response to tirofiban in acute coronary syndrome / Mutações gênicas das glicoproteínas plaquetárias e resposta ao tirofiban na síndrome coronariana aguda

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.

RESUMO CONTEXTO E OBJETIVOS: Inibidores da glicoproteína (abciximab, eptifibatide, tirofiban) são utilizados em pacientes com angina instável e infarto do miocárdio sem elevação do segmento ST (IAMSSST) antes da intervenção coronária percutânea. Dentre eles, o tirofiban é o menos eficaz. Nossa hipótese é que a resposta ao tirofiban possa estar associada a mutações no gene da glicoproteína. DESENHO E LOCAL: Estudo prospectivo na Unidade de Emergência do Instituto do Coração (InCor), Universidade de São Paulo (USP). MÉTODOS: Foram analisadas a evolução intra-hospitalar e agregabilidade plaquetária em resposta ao tirofiban de 4 mutações da glicoproteína em 50 pacientes com indicação para intervenção coronária percutânea, 17 (34%) com angina instável e 33 (66%) com IAMSSST. A agregação plaquetária foi analisada pelo método de Born. Amostras de sangue foram obtidas antes e uma hora após infusão do tirofiban. As glicoproteínas Ia (807C/T ), Ib (Thr/Met ), IIb (Ile/Ser ) e IIIa (PIA ) foram as mutações selecionadas. RESULTADOS: Hipertensão, dislipidemia, diabetes, tabagismo, doença coronariana e acidente vascular cerebral prévios foram semelhantes entre os grupos. Observou-se menor agregabilidade plaquetária dos genótipos mutantes da glicoproteína IIIa antes da administração de tirofiban do genótipo selvagem (41% ± 22% versus 56% ± 21%; P = 0,035). Genótipos mutantes da glicoproteína IIIa correlacionaram-se moderadamente com menor inibição plaquetária (r = -0,31; P = 0,030). Após a administração tirofiban, as mutações das glicoproteínas Ia, Ib, IIb, e IIIa não influenciaram o grau de inibição da agregação plaquetária e mortalidade intra-hospitalar. CONCLUSÕES: Mutações das glicoproteínas Ia, Ib, IIb e IIIa não influenciaram a agregação plaquetária em resposta ao tirofiban nos pacientes com angina instável e IAMSSST.

Comparison between intracoronary abciximab and intravenous eptifibatide administration during primary percutaneous coronary intervention of acute ST-segment elevation myocardial infarction

Administration of glycoprotein 2b/3a inhibitors is an effective adjunctive treatment strategy during primary percutaneous coronary intervention [PPCI] for ST-segment elevation myocardial infarction [STEMI]. Recent data suggest that an intracoronary administration of these drugs can increase the efficacy of PPCI. This study was done to find any potential difference in terms of efficacy of administering intracoronary Abciximab vs. intravenous Eptifibatide in primary PPCI. A total of 40 STEMI patients who underwent PPCI within 12 hours of symptom onset were randomized to either an intracoronary Abciximab [0.25 microg/kg] bolus or two boluses of intravenous Eptifibatide [0.180 microg/kg] each 10 minutes. The primary end points were enzymatic infarct size, myocardial reperfusion measured as ST-segment resolution [STR], and post-procedural thrombolysis in myocardial infarction [TIMI] grade flow of the infarct-related artery. The secondary end points were intra-procedural adverse effect [arrhythmia] and no-reflow phenomenon, in-hospital mortality, reinfarction, hemorrhage, and post-procedural global systolic function. Post-procedural TIMI grade 3 flow was achieved in 95% and 90% of the intracoronary Abciximab and intravenous Eptifibatide groups, respectively [p value = 0.61]. The infarct size, as assessed by the area under the curve of creatine phosphokinase-MB in the first 48 hours after PPCI [micromol/L/hr], was similar between the intracoronary Abciximab and intravenous Eptifibatide groups: 6591 [interquartile range [IQR], 3006.0 to 11112.0] versus 7,294 [IQR, 3795.5 to 11803.5]; p value = 0.59. Complete STR was achieved in 55% and 45% of the intracoronary Abciximab and intravenous Eptifibatide groups, respectively [p value = 0.87]. No deaths, urgent revascularizations, reinfarctions, or TIMI major bleeding events were observed in either group. The intracoronary administration of Abciximab was not superior to the intravenous administration of Eptifibatide in the STEMI patients who underwent primary PCI

Clinical Benefit of Low Molecular Weight Heparin for ST-segment Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention with Glycoprotein IIb/IIIa Inhibitor

The efficacy of low molecular weight heparin (LMWH) with low dose unfractionated heparin (UFH) during percutaneous coronary intervention (PCI) with or without glycoprotein (Gp) IIb/IIIa inhibitor compared to UFH with or without Gp IIb/IIIa inhibitor has not been elucidated. Between October 2005 and July 2007, 2,535 patients with ST elevation acute myocardial infarction (STEMI) undergoing PCI in the Korean Acute Myocardial Infarction Registry (KAMIR) were assigned to either of two groups: a group with Gp IIb/IIIa inhibitor (n=476) or a group without Gp IIb/IIIa inhibitor (n=2,059). These groups were further subdivided according to the use of LMWH with low dose UFH (n=219) or UFH alone (n=257). The primary end points were cardiac death or myocardial infarction during the 30 days after the registration. The primary end point occurred in 4.1% (9/219) of patients managed with LMWH during PCI and Gp IIb/IIIa inhibitor and 10.8% (28/257) of patients managed with UFH and Gp IIb/IIIa inhibitor (odds ratio [OR], 0.290; 95% confidence interval [CI], 0.132-0.634; P=0.006). Thrombolysis In Myocardial Infarction (TIMI) with major bleeding was observed in LMHW and UFH with Gp IIb/IIIa inhibitor (1/219 [0.5%] vs 1/257 [0.4%], P=1.00). For patients with STEMI managed with a primary PCI and Gp IIb/IIIa inhibitor, LMWH is more beneficial than UFH.

Safety, pharmacokinetic and pharmacodynamic studies of batifiban injection following single- and multiple-dose administration to healthy Chinese subjects / 华中科技大学学报（医学）（英德文版）

Batifiban, a synthetic cyclic peptide, is a potent platelet glycoprotein GPIIb/IIIa antagonist which may be useful in the treatment and prevention of acute coronary syndromes. The pharmacokinetics and pharmacodymanic (inhibition of platelet aggregation) effects, and tolerability of batifiban were investigated in healthy subjects following single bolus injection with doses of 55, 110, or 220 microg/kg, or multiple doses of an bolus followed intravenous infusion for 24 h (180 microg/kg plus 2.0 microg/min.kg, and 220 microg/kg plus 2.5 microg/min.kg) in this phase I clinical trial. Plasma levels of batifiban and areas under the curve were found to be proportional to doses. Batifiban was rapidly eliminated with a half-life of approximately 2.5 h. Significant differences were noted for plasma levels of batifiban and areas under the curve between males and females. No significant differences in the terminal half-life were found between males and females. Batifiban reversibly inhibited ex vivo platelet aggregation in a dose- and concentration-dependent manner, consistent with its mechanism as a GPIIb/IIIa antagonist. Single and multiple intravenous doses of batifiban were found to be safe and well tolerated in healthy subjects. These results support a bolus injection plus intravenous infusion regimen of batifiban for the treatment and prevention of acute coronary syndromes.

Platelet glycoprotein IIb/IIIa inhibitors in acute ischemic stroke.

Acute ischemic stroke (AIS) is a common cause of morbidity and mortality worldwide. Thrombolytic therapy with tissue plasminogen activator, the only approved treatment for AIS, is received by less than 2% of patients. Moreover, there is a slight increase in hemorrhagic complications with thrombolysis. Therefore, there is a need for newer therapeutic modalities in AIS, which could be used in window periods beyond 3-6 h after stroke onset with fewer hemorrhagic complications. Glycoprotein IIb/IIIa inhibitors (GPI), after their initial success in patients with acute coronary syndromes, promised much in patients with AIS over the past decade or so. However, their exact role in patients with AIS, including the window periods and type of strokes, and the risk of symptomatic or asymptomatic hemorrhage are unclear at the moment. The current review focuses on the literature concerning the use of GPI in AIS and looks at the available evidence regarding their use. Abciximab thought to be safe and effective in initial case series and early trials, has not been shown to improve outcomes in AIS, and is associated with higher rates of hemorrhage. Tirofiban appears to be safe and effective in initial trials and there is a need to conduct further trials to establish its role in AIS.

Safety and efficacy of indigenously developed and manufactured bivalirudin in moderate/high-risk Indian patients undergoing percutaneous coronary intervention: the Bivaflo Registry.

BACKGROUND: Current treatment strategies for percutaneous coronary intervention (PCI) and acute coronary syndrome (ACS) include concomitant use of glycoprotein IIb/IIIa inhibitors (GPI) and antithrombotic therapy such as aspirin, clopidogrel, and unfractionated or low-molecular-weight heparin. The "direct thrombin inhibitor" bivalirudin has been associated with better efficacy and safety than heparin. OBJECTIVE: The present study is performed to evaluate the safety and efficacy of an indigenously developed and manufactured bivalirudin (Bivaflo; Sun Pharmaceutical Industries Ltd., Mumbai) as the primary anticoagulation strategy during PCI in moderate-high risk patients with only provisional use of GPI. METHODS: This prospective multicentered registry enrolled 439 patients in 11 tertiary care centers across India. Patients who had ACS or other clinical/angiographic characteristics, which increase risk during PCI, were enrolled in the registry. Bivaflo was administered as a bolus dose of 0.75 mg/kg, followed by infusion at a rate of 1.75 mg/kg/h during the procedure and optionally 0.25 mg/kg/h for 4 hours after the procedure at investigator's discretion. GPI use was discouraged except as bailout. The primary endpoints were composite and individual incidences of death, myocardial infarction (MI), urgent revascularization, subacute stent thrombosis (SAT), or bleeding at day 7/hospital discharge, whichever was earlier. The secondary endpoints were 30-day composite and individual incidences of death, MI, urgent revascularization, and SAT. RESULTS: The mean age of the group was 58 +/- 10 years and 83% were males. Bivaflo was administered for a mean duration of 102 +/- 79 minutes, and 65% patients received Bivaflo infusion post-PCI. ACT values measured at 10 minutes after bolus and at the end of the PCI were found to be 339 +/- 110 and 336 +/- 104 seconds, respectively. GPI was provisionally used in only 4% (16) patients mostly due to new or suspected thrombus and obstructive dissection with decreased flow. At day 7/hospital discharge, there were no incidences of major adverse cardiac events or major bleeding. Minor bleeding occurred in only 4 patients (0.9%). The 30-day composite major adverse cardiac event rate was 0.68%. One death and two subacute thrombosis occurred during the 30-day follow-up. CONCLUSION: Bivaflo is safe and effective sole anticoagulation strategy during PCI of moderate-high risk patients. Bivaflo administration was associated with no major bleeding events and extremely low in hospital and 30-day MACE rate. These rates were lower than expected MACE rates for such a subgroup of patients based on historical controls.

Papel dos inibidores da glicoproteína IIb/IIIa na resolução do segmento ST em pacientes submetidos a angioplastia primária / The Role of Glycoprotein IIb/IIIa Inhibitor on ST Segment Resolution of Patients Submitted to Primary Angioplasty

A combinação de amgioplastia (ATC) e inhibidores da glicoproteina IIb/IIIa no tratamento do infarto agudo do miocárdio (IAM) com supradesnivelamento do segmento ST ainda apresenta reultados conflitantes. Objetivo: Determinar se o uso da glicoproteina IIb/IIIa adjunto à ATC primária está associado a maior resolução do segmento ST (RST) do eletrocardiograma (ECG). Método: No período compreendido ente 2000 e 2002, 85 pacientes foram submetidos a ATC primária, dos quais 35 utilizaram inibidores da glicoproteína IIb/IIIa de forma adjunta ao procedimento e 50 não receberam o fármaco (grupo controle). Os grupos foram comparados quanto às variáveis clínicas, eletrocardiográfica e angiográficas, demonstrando-se semelhantes. Os desfechos analisados foram RST do ECG precoce (nas primeiras seis horas após a ATC) e tardio (em 12 a 40 horas), eventos clínicos adversos maiores intra-hospitalares (ECAM) e pico enzimático. Considerou-se significativo p menor 0,05. Resultados: O grupo que recebeu inibidores da glicoproteína IIb/IIIa apresentou tendência a maior RST no ECG precoce (73 por cento vs. 62 por cento, p igual 0,08), diferença não observada quando analisado o ECG tardio (72 por cento vs. 73 por cento, p igual ns). A diferença entre a RST no ECG precoce versus tardio no grupo controle foi estatísticamente significativo (62 por cento vs. 73 por cento, p igual 0,006). Foram preditores de RST completa no ECG (maior 70 por cento), ausência de diabetes melito,...

Introduction: Combination of angioplasty PTCA and glycoprotein IIb/IIIa inhibitors (IGpIIb/IIIa) already had conflicting results in treatment of patients (pts) with ST-elevation segment myocardial infarction (STEMI). Objective: Determine if IIb/IIIa as an adjunctive therapy to the primary PTCA is associated with a better ST segment (STSR) resolution in the electrocardiogram (EKG). Methods: Of 85 patients submitted to a primary PTCA between 2000-2002, 35 used IIb/IIIa as an adjunct therapy and 50 did not use the drug (control group). Baseline characteristics were compared, and clinical, electrocardiographic and angiographic variables were similar between the groups. Outcomes analyzed were STSRs of early (first 6 hours after PTCA) and late EKGs (12 to 40 hours), in-hospital major adverse clinical cardiovascular events (MACE) and serum enzimatic peak. Significance was set at p < 0.05. Results: The IIb/IIIa group showed a trend to a better STSR in early EKGs (73% vs 62%, p = 0.08), not observed when compared late EKGs (72% vs 73%, p = ns). A significant difference was found when the STSR between early vs. late EKGs in the control group (62% vs 73%, p = 0.006), but not in in the IIb/IIIa group. Diabetes, inferior AMI, onset of symptoms in less then 6 hours and IIb/IIIa were predictors to a complete STSR (p = 0.04; OR = 3.1; IC 95% = 1 to 10). No differences were observed in the presence of in-hospital MACE or enzymatic peak. Conclusion: IIb/IIIa as an adjunctive therapy to the primary PTCA in the treatment of STEMI is associated with a better STSR in early EKG, which may indicate that the drug accelerates myocardial reperfusion in these patients.

A Multicenter, Randomized, Open-Label, Therapeutic, and Exploratory Trial to Evaluate the Tolerability and Efficacy of Platelet Glycoprotein IIb/IIIa Receptor Blocker (Clotinab(TM)) in High-Risk Patients with Percutaneous Coronary Intervention

PURPOSE: This study was designed as a multicenter, randomized, open-label study to evaluate the efficacy and tolerability of Clotinab(TM). We expected to obtain same results as with ReoPro(R) in improving ischemic cardiac complications in high-risk patients who were about to undergo percutaneous coronary intervention (PCI). PATIENTS AND METHODS: Patients of 19-80 years of age with acute coronary syndrome (ACS) who were about to undergo PCI were enrolled. After screening and confirmation of eligibility, patients were randomly assigned to different groups. Clotinab(TM) was given to 84 patients (58.7+/-10.6 years, M:F=68:16)and ReoPro(R)(59.0+/-10.5 years, M:F=30:10) was given to 40 patients before PCI. The primary efficacy endpoint was the onset of major adverse cardiac event (MACE) within 30 days from day 1. The tolerability endpoints were assessed based on bleeding, thrombocytopenia, change in Hb/Hct, human antichimetric antibody development, and adverse events. RESULTS: The number of Clotinab(TM) patients experiencing MACE was 0 out of 76 per protocol (PP) patients. The MACE rate was 0%, and its 95% exact CI was [0.00-4.74%]. A major bleeding event developed in 3 patients in the ReoPro(R) group. The probability of MACE onset in Clotinab(TM) was estimated to be less than 5%. There was no clinically significant result in tolerability variables. CONCLUSION: Clotinab(TM) is an effective and safe medicine in preventing ischemic cardiac complications for high-risk patients who will receive PCI.

Efeito protetor de antagonista das gliproteínas IIb/IIa nas alterações hepáticas e pulmonares secundárias à isquemia e reperfusão do fígado em ratos / Protective effects of an inhibitor of glycoprotein IIb/IIIa in the hepatic and pulmonary disturbances secondary to ischemia and reperfusion injury of rat’s liver

RACIONAL: A lesão de isquemia e reperfusão hepática é um evento comum e responsável por considerável morbidade e mortalidade. OBJETIVO: Avaliar efeitos de inibidor da glicoproteína IIb/IIIa, cloridrato de tirofiban, nas alterações hepáticas e pulmonares da lesão de isquemia e reperfusão de fígado de ratos. MÉTODO: Vinte e três ratos Wistar divididos em três grupos: laparotomia (n = 6), isquemia e reperfusão que receberam solução fisiológica (n = 8), e submetidos a isquemia e reperfusão e tratados com o cloridrato de tirofiban (n = 9). Foram realizadas dosagens das aminotransferases e análise histológica hepática. Avaliação pulmonar foi realizada pelo teste do azul de Evans e pela dosagem tecidual da mieloperoxidase no parênquima pulmonar. A oxidação e fosforilação mitocondrial das células hepáticas também foram avaliadas. RESULTADOS: O grupo tratado com cloridrato de tirofiban apresentou menores níveis de aminotransferases, assim como alterações histológicas menos intensas. Avaliação pulmonar demonstrou diminuição no teste de azul de Evans no grupo tratado com cloridrato de tirofiban. Grupo tratado com cloridrato de tirofiban apresentou aumento significativo do estado 3 da respiração mitocondrial e das relações adenosina difosfato utilizado para fosforilação sobre o oxigênio consumido na reação e de coeficiente respiratório. CONCLUSÕES: O uso do cloridrato de tirofiban exerceu papel protetor da lesão hepática de isquemia e reperfusão e impediu o aumento da permeabilidade vascular secundária à lesão de reperfusão hepática.

BACKGROUND Hepatic ischemia-reperfusion injury is responsible for a considerable morbidity and mortality. Aim - To evaluate the effect of a platelet glycoprotein IIb/IIIa receptor inhibitor (tirofiban) on hepatic and pulmonary disturbances associated with hepatic ischemia-reperfusion injury. METHODS: Twenty-three Wistar rats divided in three groups: rats sham-operated (n = 6), rats submitted to ischemia-reperfusion that received saline solution (n = 8), and rats submitted to ischemia-reperfusion treated with 0.7 mg/kg of tirofiban (n = 9). Serum aminotransferases (AST and ALT) were also determined, and the study of hepatic tissue histology was carried out. The evaluation of the pulmonary disturbances was done using the Evans blue test and the tissular determination of myeloperoxidase. Hepatic mitochondrial oxidation and phosphorylation were also measured. RESULTS: There was an increase in the state 3 respiration, ADP/O ratio and respiration control rate in the group treated with tirofiban. This group had also lower levels of aminotransferases and the histological findings were significantly less intense. Pulmonary evaluation demonstrated decrease of the Evans blue test in the tirofiban group and an increase of its tissular determination of myeloperoxidase. CONCLUSION: The inhibition of glycoprotein IIb/IIIa receptor with tirofiban protected the hepatic disturbances and prevented the increase of pulmonary vascular permeability secondary to the ischemia-reperfusion injury of the liver.

Tratamento clínico adjuvante no paciente diabético submetido à intervenção coronariana percutânea / Adjuvant drug treatment in diabetic patients undergoing percutaneous coronary intervention

Os autores descrevem o tratamento medicamentoso adjuvante durante e após intervenção coronária percutânea (ICP) com o objetivo de obter-se redução da taxa de eventos cardiovasculares. Parece haver relação entre a taxa de reestenose angiográfica que ocorre nos seis primeiros meses após ICP e a taxa de eventos tardios. Porém, tal relação não foi encontrada em muitos estudos. No seguimento clínico do paciente diabético após ICP, deve ser dada ênfase nas medidas gerais para controle dos fatores de risco cardiovascular. Dentre essas medidas é fundamental um controle glicêmico adequado, que pode ser obtido com as práticas clínicas habituais. Quanto à anti-agregação plaquetária, está bem estabelecido o benefício do uso combinado de aspirina e uma medicação tienopiridínica, enquanto que a utilização dos inibidores de GPIIb/IIIa como adjuvante não deve ser irrestrita em pacientes diabéticos como preconizado por muitos; a sua utilização deve ser assegurada apenas naqueles casos com uma grande carga trombótica.

The authors describe the adjuvant drug treatment during and after percutaneous coronary intervention in order to obtain the reduction of major cardiovascular events, focusing in diabetic patients. In the clinical follow-up of diabetic patients after PCI, special attention to the control measures of cardiovascular risk factors should be observed. Among those measures, a normal glicemic level is fundamental, which can be achieved with usual clinical care. Antiplatelet therapy is a controversy issue until know. Although combined antiplatelet therapy with aspirin and a thienopyridinic is well supported by a number of clinical trials, adding GPIIb/IIIa agents as adjuvants in diabetic patients should not be irrestricitve as suggested by some authors; they should be restricted to patients with a significative thrombotic burden.

[Anti GPIIB-IIIA treatment in coronary angioplasty-about 51 cases]

The glycoprotein IIb-IIIa inhibitors are extremely effective antiplatelet drugs. However their efficacy is tainted by their prohibitive cost. The objective of this work is the evaluation of the use of the glycoprotein IIb-IIIa inhibitors in the coronary angioplasty in terms of indication, patients profile and tolerance. Among the 51 patients included in the study 72,5% were treated with tirofiban; whereas 27,5% received abciximab. The glycoprotein IIb-IIIa inhibitors were respectively used in 19,6%, 43,1%, 35,3%, and 2% of the cases in the acute coronary syndromes with ST segment elevation, in the interventionnelle cardiology and the intra stent restenosis. In term of vigilance, only one major hemorrhagic accident was detected. A rigorous follow-up of the biological parameters of the patients makes it possible however to deal with this effect quickly. The introduction of a new therapeutic class, as expensive as, of antiplatelet drugs into a hospital must be the object of clinical evaluation. Finally, this study must be exercised, in particular within the framework of the pharmacovigilance

Percutaneous coronary intervention versus thrombolysis: the definite management of st elevation myocardial infarction

The management of an ST elevation myocardial infarction has undergone significant changes in the past few years. Fibrinolytic agents have become more and more clot specific increasing their efficacy. However, percutaneous coronary intervention, along with its adjuvant therapy (glycoprotein IIB/IIIA receptor inhibitors and clopidrogel), have come to challenge fibrinolytic use. Many studies have demonstrated the benefits of percutaneous coronary intervention as compared to fibrinolysis in the management of acute myocardial infarction by decreasing infarct size, myocardial function loss, and mortality

The Long-term Clinical Results of a Platelet Glycoprotein IIb/IIIa Receptor Blocker (Abciximab: ReoPro (R) ) Coated Stent in Patients with Coronary Artery Disease

BACKGROUND: Previously, the inhibition of coronary restenosis with Abciximab (ReoPro (R) ) -coated stent in a porcine model was reported. ReoPro (R) inhibits platelet aggregation, the proliferation of vascular smooth muscle cells and the inflammatory reaction. METHODS: A prospective randomized trial was performed to compare two types of stent for revascularization in the native coronary artery. The primary effective end points were major adverse coronary events (MACE) : cardiac death, acute myocardial infarction, target vessel revascularization (TVR) and restenosis at the 6-month clinical and angiographic follow-ups. RESULTS: One hundred and fifty-five patients were enrolled between August 2001 and June 2003. The mean ages (56.0 +/- 10.0 vs. 56.9 +/- 10.8 years), baseline diameter of stenosis and minimal luminal diameter were no different between the two groups. There was one myocardial infarction and revascularization during the hospital stay in control stent group. During the clinical follow-up there were two myocardial infarctions in control group. Follow-up coronary angiograms were performed in 62.3% (48/77) and 65.4% (51/78) of the coated and control groups, respectively. The diameter of stenosis and late loss were significantly less in the ReoPro (R) -coated stent group compared with the controls (16.4 +/- 5.8% vs. 34.3 +/- 6.1%, p=0.009; and 0.33 +/- 0.28 mm vs. 0.88 +/- 0.41 mm; p=0.002). The restenosis and TVR rates of the ReoPro (R) -coated stent were relatively lower compared with the control stent [14.6% (7/48) vs. 29.4% (15/51), p=0.062; and 9.2% (7/76) vs. 14.7% (11/75) ; p=0.327]. CONCLUSION: A ReoPro (R) -coated stent is safe, and may be effective in the prevention of coronary restenosis.