Platelet inhibition by abciximab bolus-only administration and oral ADP receptor antagonist loading in acute coronary syndrome patients: the blocking and bridging strategy
| Autor: | Andrea Podczeck-Schweighofer, Katharina Grohs, Jolanta M. Siller-Matula, Marcel Francesconi, Thomas Hafner, Eva Wilhelm, Günter Christ |
|---|---|
| Rok vydání: | 2013 |
| Předmět: |
Adult
Blood Platelets Male Acute coronary syndrome medicine.medical_specialty Prasugrel Ticlopidine Platelet Aggregation Platelet Function Tests medicine.medical_treatment Abciximab Administration Oral Platelet Glycoprotein GPIIb-IIIa Complex Thiophenes Piperazines chemistry.chemical_compound Immunoglobulin Fab Fragments Bolus (medicine) Thrombin Internal medicine medicine Humans Acute Coronary Syndrome Aged business.industry Drug Administration Routes Percutaneous coronary intervention Antibodies Monoclonal Hematology Middle Aged medicine.disease Clopidogrel Adenosine diphosphate chemistry Cardiology Purinergic P2Y Receptor Antagonists Female business Prasugrel Hydrochloride Platelet Aggregation Inhibitors medicine.drug |
| Zdroj: | Thrombosis research. 132(1) |
| ISSN: | 1879-2472 |
| Popis: | Current guidelines still recommend the bolus and infusion administration of glycoprotein IIbIIIa inhibitors in patients with high-risk acute coronary syndrome undergoing percutaneous coronary intervention. We sought to evaluate the extent of platelet inhibition by a blocking and bridging strategy with intracoronary abciximab bolus-only administration and oral loading of adenosine diphosphate receptor antagonists.Fifty-six consecutive high-risk acute coronary syndrome patients with bolus-only abciximab administration (0.25 mg/kg i.c.) and loading with 600 mg clopidogrel (55%) or 60 mg prasugrel (45%) were included in this study. Platelet aggregation induced by thrombin receptor-activating peptide and adenosine diphosphate was measured by multiple electrode aggregometry up to 7 days.Thrombin receptor-activating peptide induced platelet aggregation was significantly suppressed for a minimum of 48 h (45±17U) and returned to a normal range (84 U) after 6 days (90±26U; p0.001). Co-medication with prasugrel significantly reduced adenosine diphosphate-induced (p=0.002) and thrombin receptor-activating peptide-induced (p=0.02) platelet aggregation compared with clopidogrel throughout the observation period. No stent thrombosis or repeat myocardial infarction occurred at 30-day follow-up.Immediate blocking of platelet aggregation in high-risk acute coronary syndrome patients by intracoronary abciximab bolus-only administration and bridging to prolonged inhibition via oral blockade of ADP receptors effectively inhibited overall platelet reactivity for at least 48 h, questioning the value of continuous abciximab infusion. Co-medication with prasugrel vs. clopidogrel synergistically augmented platelet inhibition. |
| Databáze: | OpenAIRE |
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