ABSTRACT
Cumulative scientific evidence gathered over the past ten years has confirmed the role of platelet GP IIb/IIIa inhibitors in reducing ischemic complications of patients undergoing percutaneous coronary intervention (PCI). Recently, mortality data available on more than 20,000 patients enrolled in randomized clinical trials suggest that GP IIb/IIIa blockade also improves short and long-term survival after PCI. Despite convincing arguments, GP IIb/IIIa inhibitors are still inconsistently administered in patients undergoing coronary intervention. The following review will discuss the scientific grounds and the principal controversies surrounding the use of these compounds in patients undergoing elective percutaneous coronary intervention.
Subject(s)
Angioplasty, Balloon, Coronary/adverse effects , Myocardial Ischemia/prevention & control , Platelet Aggregation Inhibitors/therapeutic use , Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors , Animals , Clinical Trials as Topic , Humans , Myocardial Ischemia/blood , Myocardial Ischemia/etiology , Myocardial Ischemia/mortality , Platelet Aggregation Inhibitors/administration & dosage , Platelet Aggregation Inhibitors/adverse effectsABSTRACT
Percutaneous coronary angioplasty and stenting is widely used for the treatment of patients with coronary artery disease. Glycoprotein (GP) IIb-IIIa inhibitors represent a new class of drugs with proven efficacy in reducing ischemic complications of patients undergoing percutaneous coronary intervention (PCI). One of these, eptifibatide (Integrilin feminine, COR), is a small molecule inhibitor of glycoprotein IIb-IIIa receptors which has been studied extensively in patients undergoing PCI. In both IMPACT II and ESPRIT trials, patients treated with eptifibatide experienced a reduction in the rate of ischemic complications compared to those treated with placebo. These landmark studies, which are the focus of this review, emphasize the importance of considering the use of GP IIb-IIIa inhibitors in all patients undergoing PCI.
Subject(s)
Angioplasty, Balloon, Coronary , Coronary Disease/therapy , Peptides/therapeutic use , Platelet Aggregation Inhibitors/therapeutic use , Platelet Glycoprotein GPIIb-IIIa Complex/antagonists & inhibitors , Stents , Adult , Aged , Clinical Trials, Phase I as Topic , Clinical Trials, Phase II as Topic , Clinical Trials, Phase III as Topic , Coronary Disease/drug therapy , Eptifibatide , Humans , Middle Aged , Multicenter Studies as Topic , Peptides/adverse effects , Placebos , Platelet Aggregation Inhibitors/adverse effects , Randomized Controlled Trials as Topic , Risk AssessmentABSTRACT
Some patients experience discomfort at sheath removal during transradial procedures. We hypothesized that the use of a hydrophilic-coated sheath (HCS) would reduce the traction force needed at withdrawal and therefore the pain experienced by patients. Patients referred for coronary intervention were randomized to undergo transradial procedure with the use of HCS or with nonhydrophilic sheath (NHS). At removal of the sheath, peak traction force was recorded using an electronic traction gauge and patients were asked to quantify their pain. A total of 90 patients participated in the study. The mean +/- SD peak traction force at sheath removal was 265 +/- 167 g and 865 +/- 318 g in the HCS and NHS groups, respectively (69% reduction; P < 0.001). Mean maximal pain score was 0.6 +/- 1.2 and 4.8 +/- 2.9 in the HCS and NHS groups, respectively (88% reduction; P < 0.0001). Use of HCS for transradial procedures reduces considerably the traction force needed for sheath removal as well as pain experienced by patients when compared to NHS.
Subject(s)
Device Removal , Radial Artery/surgery , Age Factors , Aged , Angina Pectoris/complications , Angina Pectoris/diagnostic imaging , Angina Pectoris/therapy , Angioplasty, Balloon, Coronary/instrumentation , Catheterization , Coronary Angiography/instrumentation , Echocardiography, Doppler , Endpoint Determination , Equipment Design , Female , Humans , Male , Middle Aged , Pain/etiology , Sex Factors , TractionABSTRACT
This randomized study was carried out to compare pain factors of Vabra and Endocell by an ordered classification of one to ten to evaluate the respective pathological yield and to establish the clinical acceptability. Patients had endometrial evaluation either for abnormal bleeding, abnormal endometrial line as demonstrated by echography or abnormal endometrial cells in the Pap smear. Age, gravidity, parity and hysterometry were similar in both groups, with abnormal bleeding being the most frequent indication (250/370 patients, 67.5%). Both techniques yielded equal results for insufficient tissue retrieval at 46/184 (25.0%) for Vabra and at 50/183 (27.3%) for Endocell. The pain score differed significantly in favor of Wallach Endocell at 4.36+/-2.38 versus Vabra at 5.65+/-2.41 (p=0.001). Vabra and Endocell give similar pathological results; however, Endocell is significantly less painful and easier to manipulate and carry because of its weight (1.69 g vs. 37.80 g).
Subject(s)
Curettage/instrumentation , Endometrium/pathology , Uterine Diseases/diagnosis , Adult , Aged , Endometrial Neoplasms/diagnosis , Endometrial Neoplasms/pathology , Female , Humans , Middle Aged , Papanicolaou Test , Parity , Uterine Diseases/pathology , Uterine Hemorrhage , Vaginal SmearsABSTRACT
Forty-six eligible women with metastatic endometrial cancer were randomly allocated to receive monthly cycles of either CAF (cyclophosphamide, adriamycin, 5-fluorouracil) or CAF plus Provera 200 mg daily for 3 weeks followed cyclically by Tamoxifen 20 mg daily for 3 weeks. Overall response rates of 15 and 43% were seen with CAF and CAF plus hormonal therapy. Using a multivariate analysis of the results, this difference is significant (P value 0.05). In 8 patients with operable endometrial cancer, negative estrogen receptor concentration (ER less than 15 fmole/mg protein) and Grade 3 disease, the clinical course was aggressive in 4 patients with systemic and local relapse. In 10 other similar patients (negative ER and Grade 3) who received adjuvant cyclical hormonal therapy only 1 relapsed and the other 9 are disease-free for an average of more than 31 months. Sequential cyclical hormonal therapy with ER and progesterone receptor analysis has a place in the management of endometrial carcinoma.
