Thromb Haemost 2008; 100(04): 648-654
DOI: 10.1160/TH08-03-0190
Cardiovascular Biology and Cell Signalling
Schattauer GmbH

Tirofiban optimizes platelet inhibition for immediate percutaneous coronary intervention in high-risk acute coronary syndromes

Boris T. Ivandic*
1   Department of Medicine III, University of Heidelberg, Heidelberg, Germany
,
Kerstin Kurz*
1   Department of Medicine III, University of Heidelberg, Heidelberg, Germany
,
Frieder Keck
1   Department of Medicine III, University of Heidelberg, Heidelberg, Germany
,
Peter Staritz
1   Department of Medicine III, University of Heidelberg, Heidelberg, Germany
,
Stephanie Lehrke
1   Department of Medicine III, University of Heidelberg, Heidelberg, Germany
,
Hugo A. Katus
1   Department of Medicine III, University of Heidelberg, Heidelberg, Germany
,
Evangelos Giannitsis
1   Department of Medicine III, University of Heidelberg, Heidelberg, Germany
› Author Affiliations
Financial support: This study was supported grants from Bristol-Myers Squibb, Germany.
Further Information

Publication History

Received 27 March 2008

Accepted after minor revision 09 July 2008

Publication Date:
22 November 2017 (online)

Zoom Image

Summary

It was the aim of this study to compare the efficacy of early platelet inhibition by 600 mg clopidogrel and acetylsalicylic acid (ASA) to a triple therapy including a glycoprotein IIb-IIIa receptor blocker. Immediate percutaneous coronary intervention (PCI) is recommended for high-risk acute coronary syndromes. In this setting the efficacy of platelet inhibition is unknown. One hundred patients were randomized to receive ASA and 600 mg clopidogrel, or additional open-label tirofiban (bolus of 10 µg/kg body weight followed by continued infusion of 0.15 µg/kg body weight per minute) as soon as non-ST - segment elevation myocardial infarction was diagnosed. The primary endpoint was the reduction of infarct size determined by post-interventional increases of cardiac troponin T (cTnT). Secondary endpoints included platelet function measured by optical and impedance aggregometry using ADP (5 and 20 µM) and collagen (1 µg/ml) as platelet agonists. Tirofiban maximized platelet inhibition (p<0.0001) immediately and was associated with significantly lower post-interventional cTnT concentrations (p=0.0352). In the dual platelet inhibition arm, clopidogrel was not effective in 69% of patients at the time of coronary intervention, and still in 47%, if pre-treatment time was >120 minutes. The frequency of cardiovascular (death, myocardial infarction, revascularization) and bleeding events was comparable. Platelet aggregation is not adequately inhibited in cTnT - positive patients in the setting of immediate PCI with very short pre-treatment times. Only tirofiban provided consistent and effective inhibition of platelet aggregation at the time of immediate or very early invasive therapy.

* These authors contributed equally.