PMID- 15247961
OWN - NLM
STAT- MEDLINE
DCOM- 20040921
LR  - 20181130
IS  - 0022-9032 (Print)
IS  - 0022-9032 (Linking)
VI  - 60
IP  - 5
DP  - 2004 May
TI  - Platelet inhibition by increased tirofiban dosing during primary coronary 
      angioplasty for ST elevation myocardial infarction.
PG  - 459-67
AB  - BACKGROUND: Platelet receptor IIb/IIIa inhibition during percutaneous coronary 
      interventions (PCI) decreases incidence of major adverse cardiac events (MACE). 
      These effects directly result from the level of platelet inhibition. Due to 
      existing data indicating that standard dosing of tirofiban is insufficient for 
      optimal platelet inhibition, we proposed a novel, experimental dosing. AIM: In 
      this study we assessed, with the use of Ultegra Rapid Platelet Function Assay 
      (RFPA), the level of platelet inhibition with increased tirofiban dosing during 
      primary PCI for ST elevation myocardial infarction (STEMI). METHODS: Twenty eight 
      patients (22 males, 6 females, mean age 63 years, range 32-78 years) with STEMI 
      were included into the study. All patients received 300 mg of aspirin, iv. 
      heparin in a dose of 10 000 IU, which was followed by platelet receptor GP 
      IIb/IIIa inhibitor tirofiban - 10 micro g/kg iv bolus, 0.4 micro g/kg/min for 30 
      min and infusion 0.1 micro g/kg/min continued for 12-24 h. Platelet function was 
      assessed with RFPA before tirofiban administration and after 10, 30, 90 minutes 
      as well as 8 hours from the initial dose of tirofiban. Baseline fibrinogen 
      binding to platelet receptor IIb/IIIa was defined as PAU (platelet aggregation 
      unit) and the effects of tirofiban on platelets were expressed as a percentage of 
      platelet inhibition. RESULTS: During in-hospital stay, no deaths, re-infarction 
      nor recurrences of ischaemia requiring intervention were noted. The mean total 
      duration of tirofiban administration was 21 hours. Thrombocytopenia was not 
      observed in any patient. Bleeding complications occurred in 5 (17.9%) patients. 
      Blood transfusion was required in three patients. The percentages of platelet 
      inhibition measured at the pre-specified time-points were 95%, 94%, 91% and 87%, 
      respectively. In 32% of patients an inhibition of platelet exceeding 95%, 
      measured 10 minutes from the onset of tirofiban infusion, was not achieved. At 
      the same time, platelet inhibition <90% was found in only 3 (11%) patients. Eight 
      hours from the initiation of tirofiban, platelet inhibition <70% was found in 3 
      (11%) patients; of them, two had platelet inhibition <95% when measured 10 
      minutes from the onset of therapy with tirofiban. CONCLUSIONS: 1. Increased 
      dosing of tirofiban resulted in an enhanced platelet inhibition. 2. Optimal 
      platelet inhibition, especially during first minutes of drug administration, was 
      not achieved in a substantial number of patients. 3. Increased IIb/IIIa inhibitor 
      dosing resulted in a high partial and normal baseline coronary flow in an 
      infarct-related artery. 4. Increased tirofiban dosing resulted in a relatively 
      high bleeding complications rate.
FAU - Kralisz, Pawel
AU  - Kralisz P
AD  - Department of Invasive Cardiology, Medical Academy, Bialystok, Poland.
FAU - Dobrzycki, Slawomir
AU  - Dobrzycki S
FAU - Nowak, Konrad
AU  - Nowak K
FAU - Kochman, Waclaw
AU  - Kochman W
FAU - Gajewska-Bachorzewska, Hanna
AU  - Gajewska-Bachorzewska H
FAU - Gugala, Kamil
AU  - Gugala K
FAU - Mezynski, Grzegorz
AU  - Mezynski G
FAU - Prokopczuk, Przemyslaw
AU  - Prokopczuk P
FAU - Zuk, Jerzy
AU  - Zuk J
FAU - Korecki, Janusz
AU  - Korecki J
FAU - Poniatowski, Boguslaw
AU  - Poniatowski B
FAU - Musial, Wlodzimierz
AU  - Musial W
LA  - eng
LA  - pol
PT  - Clinical Trial
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - Poland
TA  - Kardiol Pol
JT  - Kardiologia polska
JID - 0376352
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 42HK56048U (Tyrosine)
RN  - GGX234SI5H (Tirofiban)
SB  - IM
MH  - Adult
MH  - Aged
MH  - *Angioplasty, Balloon, Coronary
MH  - Blood Platelets/*drug effects
MH  - Electrocardiography
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/physiopathology/*therapy
MH  - Platelet Aggregation Inhibitors/*administration & dosage/adverse effects
MH  - Time Factors
MH  - Tirofiban
MH  - Treatment Outcome
MH  - Tyrosine/*administration & dosage/adverse effects/*analogs & derivatives
EDAT- 2004/07/13 05:00
MHDA- 2004/09/24 05:00
CRDT- 2004/07/13 05:00
PHST- 2004/07/13 05:00 [pubmed]
PHST- 2004/09/24 05:00 [medline]
PHST- 2004/07/13 05:00 [entrez]
PST - ppublish
SO  - Kardiol Pol. 2004 May;60(5):459-67.