PMID- 16139336
OWN - NLM
STAT- MEDLINE
DCOM- 20070111
LR  - 20181201
IS  - 0049-3848 (Print)
IS  - 0049-3848 (Linking)
VI  - 118
IP  - 3
DP  - 2006
TI  - Increased expression of platelet P-selectin and formation of platelet-leukocyte 
      aggregates in blood from patients treated with unfractionated heparin plus 
      eptifibatide compared with bivalirudin.
PG  - 361-9
AB  - INTRODUCTION: Platelet-leukocyte aggregates have been implicated in 
      atherogenesis. This study was designed to determine the influence in vivo of a 
      direct thrombin inhibitor, bivalirudin, compared with unfractionated heparin 
      (UFH) plus the GP IIb-IIIa inhibitor eptifibatide (E) on platelet reactivity, the 
      formation of platelet-leukocyte aggregates, and leukocyte activation. MATERIALS 
      AND METHODS: Blood was taken before and after percutaneous coronary intervention 
      (PCI) from 60 patients randomized to UFH+E (n=26) or bivalirudin (n=34). Platelet 
      function and the formation in vivo of platelet-monocyte aggregates (PMA) and 
      platelet-neutrophil aggregates (PNA) were assessed with the use of flow 
      cytometry. Myeloperoxidase (MPO) elaborated during leukocyte activation was 
      measured by ELISA. RESULTS: Compared with those treated with bivalirudin, 
      patients treated with UFH+E exhibited a 45% decrease in the capacity of platelets 
      to bind fibrinogen (p=0.006) but a 2-fold increase in platelet surface expression 
      of P-selectin (p=0.04) in samples taken from the coronary ostium before PCI. 
      Platelet-leukocyte aggregation in vivo was greater (PMA=2-fold, p=0.04; 
      PNA=3-fold, p=0.006) with UFH+E as was the concentration in blood of MPO 
      (1.5-fold, p=0.007). CONCLUSIONS: Increased platelet surface expression of 
      P-selectin, augmented platelet-leukocyte aggregation in vivo, and consequent 
      activation of leukocytes was seen before PCI in blood from patients treated with 
      UFH+E compared with bivalirudin. Benefits associated with decreased platelet 
      aggregation when PCI is performed with UFH plus GP IIb-IIIa inhibition may be 
      partially offset by increased platelet-leukocyte aggregation.
FAU - Keating, Friederike K
AU  - Keating FK
AD  - Cardiology Unit, Department of Medicine, University of Vermont/Fletcher Allen 
      Health Care, 111 Colchester Avenue, Burlington, VT 05401, USA. 
      friederike.keating@vtmednet.org
FAU - Dauerman, Harold L
AU  - Dauerman HL
FAU - Whitaker, Deborah A
AU  - Whitaker DA
FAU - Sobel, Burton E
AU  - Sobel BE
FAU - Schneider, David J
AU  - Schneider DJ
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20050901
PL  - United States
TA  - Thromb Res
JT  - Thrombosis research
JID - 0326377
RN  - 0 (Anticoagulants)
RN  - 0 (Drug Combinations)
RN  - 0 (Hirudins)
RN  - 0 (P-Selectin)
RN  - 0 (Peptide Fragments)
RN  - 0 (Peptides)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - 0 (Recombinant Proteins)
RN  - 9005-49-6 (Heparin)
RN  - NA8320J834 (Eptifibatide)
RN  - TN9BEX005G (bivalirudin)
SB  - IM
MH  - Anticoagulants/administration & dosage
MH  - Cells, Cultured
MH  - Drug Combinations
MH  - Eptifibatide
MH  - Female
MH  - Heparin/*administration & dosage
MH  - Hirudins/*administration & dosage
MH  - Humans
MH  - Leukocytes/drug effects/immunology
MH  - Male
MH  - Middle Aged
MH  - P-Selectin/*immunology
MH  - Peptide Fragments/*administration & dosage
MH  - Peptides/*administration & dosage
MH  - Platelet Aggregation/*drug effects/*immunology
MH  - Platelet Aggregation Inhibitors/administration & dosage
MH  - Recombinant Proteins/administration & dosage
MH  - Thrombosis/blood/*immunology/prevention & control
EDAT- 2005/09/06 09:00
MHDA- 2007/01/12 09:00
CRDT- 2005/09/06 09:00
PHST- 2005/03/21 00:00 [received]
PHST- 2005/07/16 00:00 [revised]
PHST- 2005/07/22 00:00 [accepted]
PHST- 2005/09/06 09:00 [pubmed]
PHST- 2007/01/12 09:00 [medline]
PHST- 2005/09/06 09:00 [entrez]
AID - S0049-3848(05)00344-0 [pii]
AID - 10.1016/j.thromres.2005.07.020 [doi]
PST - ppublish
SO  - Thromb Res. 2006;118(3):361-9. doi: 10.1016/j.thromres.2005.07.020. Epub 2005 Sep 
      1.