期刊
JACC-CARDIOVASCULAR INTERVENTIONS
卷 5, 期 3, 页码 268-277出版社
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jcin.2012.01.006
关键词
aggregometry; bolus; clopidogrel; prasugrel; tirofiban
资金
- Iroko Cardio
- Merck
- Eli Lilly
- Medtronic
- Servier
- Novartis
- Roche
- Boehringer Ingelheim
Objectives The authors sought to compare the effect on inhibition of platelet aggregation (IPA) of prasugrel therapy versus tirofiban bolus with or without a post-bolus short drug infusion in ST-segment elevation myocardial infarction (STEMI) patients. Background The degree and rapidity of IPA after prasugrel alone with or without concomitant glycoprotein IIb/IIIa inhibition in STEMI patients is unknown. Methods A total of 100 STEMI patients randomly received prasugrel 60 mg versus 25 mu g/kg tirofiban bolus with or without post-bolus 2-h infusion of tirofiban, with or without concomitant prasugrel. IPA at light transmission aggregometry was performed throughout 24 h. The primary endpoint was IPA stimulated with 20 mu mol/l adenosine diphosphate (ADP) at 30 min. Results At 30 min, patients in the prasugrel group showed a significantly lower IPA to 20 mu mol/l ADP stimulation as compared with tirofiban-treated patients (36 +/- 35 vs. 87 +/- 31, p < 0.0001). Similarly, patients taking prasugrel showed a suboptimal degree of platelet inhibition for at least 2 h compared with tirofiban patients. Post-bolus tirofiban infusion was necessary to maintain a high level of IPA beyond 1 h after bolus administration if concomitant clopidogrel was given, whereas the bolus-only tirofiban and concomitant prasugrel led to the higher and more consistent IPA levels after both ADP and thrombin receptor-activating peptide stimuli than either therapy alone. Conclusions Our study shows that prasugrel administration leads to a suboptimal IPA for at least 2 h in STEMI patients. Yet, prasugrel, given in association with a bolus only of glycoprotein IIb/IIIa inhibitor, obviates the need of post-bolus infusion and almost completely abolishes residual variability of IPA after treatment. (Facilitation through Aggrastat By drOpping or shortening Infusion Line in patients with ST-segment elevation myocardial infarction compared to or on top of PRasugrel given at loading dOse [The FABOLUS PRO trial]; NCT01336348) (J Am Coll Cardiol Intv 2012;5:268-77) (C) 2012 by the American College of Cardiology Foundation
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