Randomized trial of a GPIIb/IIIa platelet receptor blocker in refractory unstable angina. European Cooperative Study Group
| Autor: | Wolfgang Rutsch, D de Bono, Gr. Heyndrickx, J. C. A. Hoorntje, M. L. Simoons, M. J. De Boer, T F Schaible, L R van der Wieken, M. van den Brand, A. J. M. Van Miltenburg |
|---|---|
| Rok vydání: | 1994 |
| Předmět: |
Adult
Male Integrins Bleeding Time Platelet Function Tests Abciximab Myocardial Ischemia Platelet Glycoprotein GPIIb-IIIa Complex Coronary Angiography Placebo Angina Immunoglobulin Fab Fragments Postoperative Complications Bleeding time Physiology (medical) medicine Humans Platelet Angina Unstable Myocardial infarction Angioplasty Balloon Coronary Aged Aspirin medicine.diagnostic_test business.industry Unstable angina Antibodies Monoclonal Middle Aged medicine.disease Treatment Outcome Anesthesia Female Cardiology and Cardiovascular Medicine business TIMI medicine.drug |
| Zdroj: | Circulation. 89:596-603 |
| ISSN: | 1524-4539 0009-7322 |
| DOI: | 10.1161/01.cir.89.2.596 |
| Popis: | BACKGROUND Patients with unstable angina despite intensive medical therapy, ie, refractory angina, are at high risk for developing thrombotic complications: myocardial infarction or coronary occlusion during percutaneous transluminal coronary angioplasty (PTCA). Chimeric 7E3 (c7E3) Fab is an antibody fragment that blocks the platelet glycoprotein (GP) IIb/IIIa receptor and potently inhibits platelet aggregation. METHODS AND RESULTS To evaluate whether potent platelet inhibition could reduce these complications, 60 patients with dynamic ST-T changes and recurrent pain despite intensive medical therapy were randomized to c7E3 Fab or placebo. After initial angiography had demonstrated a culprit lesion suitable for PTCA, placebo or c7E3 Fab was administered as 0.25 mg/kg bolus injection followed by 10 micrograms/min for 18 to 24 hours until 1 hour after completion of second angiography and PTCA. During study drug infusion, ischemia occurred in 9 c7E3 Fab and 16 placebo patients (P = .06). During hospital stay, 12 major events occurred in 7 placebo patients (23%), including 1 death, 4 infarcts, and 7 urgent interventions. In the c7E3 Fab group, only 1 event (an infarct) occurred (3%, P = .03). Angiography showed improved TIMI flow in 4 placebo and 6 c7E3 Fab patients and worsening of flow in 3 placebo patients but in none of the c7E3 Fab patients. Quantitative analysis showed significant improvement of the lesion in the patients treated with c7E3 Fab, which was not observed in the placebo group, although the difference between the two treatment groups was not significant. Measurement of platelet function and bleeding time demonstrated > 90% blockade of GPIIb/IIIa receptors, > 90% reduction of ex vivo platelet aggregation to ADP, and a significantly prolonged bleeding time during c7E3 Fab infusion, without excess bleeding. CONCLUSIONS Combined therapy with c7E3 Fab, heparin, and aspirin appears safe. These pilot study results support the concept that effective blockade of the platelet GPIIb/IIIa receptors can reduce myocardial infarction and facilitate PTCA in patients with refractory unstable angina. |
| Databáze: | OpenAIRE |
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