Reference

Distinct yet complementary mechanisms of heparin and glycoprotein iib/iiia inhibitors on platelet activation and aggregation: Implications for restenosis during percutaneous coronary intervention

Distinct yet complementary mechanisms of heparin and glycoprotein iib/iiia inhibitors on platelet activation and aggregation: Implications for restenosis during percutaneous coronary intervention. Day, J. R. S.; Malik, I. S.; Weerasinghe, A.; Poullis, M.; Nadra, I.; Haskard, D. O.; Taylor, K.There are some reagents with their cas registry numbers 9041-08-1 and 142373-60-2 are used in this study. M.; Landis, R. C. (London, UK). Heart (London, United Kingdom), 90(7), 794-799 (English) 2004 BMJ Publishing Group. CODEN: HEARFR. ISSN: 1355-6037. DOCUMENT TYPE: Journal CA Section: 1 (Pharmacology) Section cross-reference(s): 15 Objective: To study the effect of unfractionated heparin (UFH) vs. low mol. wt. heparin (LMWH) in combination with glycoprotein (Gp) IIb/IIIa blockers on platelet activation and aggregation. Methods: Washed platelets were stimulated with thrombin in the presence or absence of UFH (monoparin), LMWH (enoxaparin), and a Gp IIb/IIIa blocker (abciximab, eptifibatide, or tirofiban). Results: Although Gp IIb/IIIa antagonists blocked the final common pathway of thrombin induced platelet aggregation, UFH and LMWH were better at blocking upstream platelet activation. UFH was significantly more effective than LMWH at inhibiting P selectin expression (p = 0.001) and platelet derived growth factor release from thrombin activated platelets (p = 0.012). Conclusions: UFH and LMWH exert complementary effects to Gp IIb/IIIa blockers by inhibiting afferent pathways of platelet activation. Coadministration of heparin with Gp IIb/IIIa blockers provides improved protection against persistent platelet activation, thereby improving outcome after percutaneous coronary intervention. Judging from these data, UFH may be more effective in this regard than LMWH, at least in vitro. The use of LMWH in preference to UFH during percutaneous coronary intervention, although initially attractive, may inadequately protect against platelet activation despite the presence of Gp IIb/IIIa blockers. .

High-Dose BoluS TiRofibAn and Sirolimus Eluting STEnt versus Abiciximab and Bare Metal Stent in Acute Myocardial Infarction (STRATEGY) Study-Protocol Design and Demography of the First 100 Patients

High-Dose BoluS TiRofibAn and Sirolimus Eluting STEnt versus Abiciximab and Bare Metal Stent in Acute Myocardial Infarction (STRATEGY) Study-Protocol Design and Demography of the First 100 Patients. Valgimigli, Marco; Percoco, Gianfranco; Cicchitelli, Giordano; Ferrari, Fabrizio; Barbieri, Dario; Ansani, Lucia; Guardigli, Gabriele; Parrinello, Giovanni; Malagutti, Patrizia; Soukhomovskaia, Olga; Bettini, Alessandro; Campo, Gianluca; Ferrari, Roberto (Chair of Cardiology, University of Ferrara, Italy). Cardiovascular Drugs and Therapy, 18(3), 225-230 (English) 2004 Kluwer Academic Publishers. CODEN: CDTHET.Chemicals with cas numbers 143653-53-6 and 142373-60-2 also play role. ISSN: 0920-3206. DOCUMENT TYPE: Journal CA Section: 1 (Pharmacology) Background: Primary bare metal stenting and abciximab infusion are currently considered the best available reperfusion strategy for acute ST-segment elevation myocardial infarction (STEMI). Sirolimus eluting stents (SES), compared to bare metal stent (BMS), greatly reduce the incidence of binary restenosis and target vessel revascularization (TVR), but their use on a routine basis results in a significant increase in medical costs. With current European list prices, the use of tirofiban instead of abciximab would save enough money to absorb the difference between SES and BMS. Aim: To assess whether in patients with STEMI the combination of SES with high dose bolus (HDB) tirofiban results in a similar incidence of major cardiovascular events (MACE) but in a lower binary restenosis rate after six months compared to BMS and abciximab. Methods and Results: 160 patients are required to satisfy the primary composite end-point, including MACE and binary restenosis. The study is ongoing: the current paper focuses on the methodol. and demog. of the first 100 patients so far enrolled. Patients randomized to HDB tirofiban (n = 50, mean age: 62±12, 40 males) and abciximab (n = 50, mean age: 63±12, 38 males) do not differ for medical history, presentation profile, medications at discharge, angiog. profile and creatine-kinase MB-fraction at peak. Conclusions: The results of the trial will be available by the end of 2004: they will be crucial for the cardiologists to know whether the gold std. for AMI treatment should be reconsidered after the introduction of SES into the clin. practice. .