التفاصيل البيبلوغرافية
| العنوان: |
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, and eptifibatide (PEACE) study. |
| المؤلفون: |
Dalby, Miles1, Montalescot, Gilles1 gilles.montalescot@psl.ap-hop-paris.fr, Sollier, Claire Bal dit2, Vicaut, Eric3, Soulat, Thierry2, Collet, Jean-Philippe1, Choussat, Rémi1, Gallois, Vanessa1, Drobinski, Gérard1, Drouet, Ludovic2, Thomas, Daniel1, Bal dit Sollier, Claire (AUTHOR), Choussat, Rémi (AUTHOR), Drobinski, Gérard (AUTHOR) |
| المصدر: |
Journal of the American College of Cardiology (JACC). Jan2004, Vol. 43 Issue 2, p162-168. 7p. |
| مصطلحات موضوعية: |
*BLOOD platelets, *THROMBIN, *PYRIDINE, *GLYCOPROTEINS |
| مستخلص: |
: ObjectivesThe 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.: BackgroundAlthough 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.: MethodsThirty-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.: ResultsAfter 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.: ConclusionsThe 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. [Copyright &y& Elsevier] |
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