Title of article :
Eptifibatide provides additional platelet inhibition in Non–ST-Elevation myocardial infarction patients already treated with aspirin and clopidogrel: Results of the platelet activity extinction in Non–Q-Wave myocardial infarction with aspirin, clopidogrel
Author/Authors :
Miles Dalby، نويسنده , , Gilles Montalescot، نويسنده , , Claire Bal dit Sollier، نويسنده , , Eric Vicaut، نويسنده , , Thierry Soulat، نويسنده , , Jean-Philippe Collet، نويسنده , , Rémi Choussat، نويسنده , , Vanessa Gallois، نويسنده , , Gérard Drobinski، نويسنده , , Ludovic Drouet، نويسنده , , Daniel Thomas، نويسنده ,
Issue Information :
روزنامه با شماره پیاپی سال 2004
Abstract :
Objectives
The present study hypothesis was that eptifibatide offered further antiplatelet efficacy above clopidogrel in non–ST-elevation myocardial infarction (NSTEMI) patients before an expeditive coronary intervention.
Background
Although thienopyridines and glycoprotein (GP) IIb/IIIa antagonists are often co-prescribed in the context of NSTEMI, the antiplatelet interaction of these agents is poorly described and the superiority of GP IIb/IIIa antagonists above thienopyridine treatment alone is not clear.
Methods
Thirty-two NSTEMI patients treated with aspirin and enoxaparin were studied using flow cytometry to define parameters of platelet activation with a panel of agonists before clopidogrel, after clopidogrel, and during an eptifibatide infusion following the clopidogrel load.
Results
After platelet activation with adenosine diphosphate, thrombin receptor-activating peptide, or U46-619, relative reductions in conformationally activated GP IIb/IIIa receptor expression (evaluated with PAC-1) of 48%, 43%, and 33%, respectively (all p < 0.0001), were seen with clopidogrel, but further 80%, 78%, and 72% (all p < 0.0001) reductions were seen with eptifibatide. With the same agonists, fibrinogen binding was significantly reduced after clopidogrel by 70%, 64%, and 81% (all p < 0.0001) and again further reduced with eptifibatide by 90%, 95%, and 69% (all p < 0.0001). The total number of GP IIb/IIIa receptors (measured as P2 expression) and P-selectin expression fell after clopidogrel, after ex vivo stimulation with the same agonists; however, both parameters increased slightly during the eptifibatide infusion.
Conclusions
The activated GP IIb/IIIa expression and fibrinogen binding findings indicate that eptifibatide provides significant potent antiplatelet activity above aspirin and clopidogrel, suggesting additive immediate protection in the treatment of NSTEMI. The P2 and P-selectin findings suggest the possibility of a partial agonist and/or pro-inflammatory effect.
Keywords :
fibrinogen , MAb , PCI , monoclonal antibody , intravenous , Glycoprotein , Peace , Percutaneous coronary intervention , GP , IV , TRAP , Ri , ADP , adenosine diphosphate , Fg , NSTEMI , non–ST-elevation myocardial infarction , Platelet activity Extinction in non–Q-wave myocardial infarction with Aspirin Clopidogrel and Eptifibatide study , relative increase , RR , relative reduction , thrombin receptor-activating peptide
Journal title :
JACC (Journal of the American College of Cardiology)
Journal title :
JACC (Journal of the American College of Cardiology)