急性进展性脑梗死患者应用替罗非班的临床疗效和安全性观察

目的 探讨替罗非班用于急性进展性脑梗死患者治疗中的临床疗效及治疗安全性。方法 选取2019年1—12月在我院接受治疗的急性进展性脑梗死患者88例,依据随机数字表法分为两组,每组各44例。对照组实施常规氯吡格雷+拜阿司匹林治疗的,观察组实施常规用药+替罗非班治疗。比较两组护理干预后患者日常生活能力、神经功能改善情况、对血小板功能影响情况以及治疗期间不良事件发生情况。结果 观察组治疗7 d、14 d后的NIHSS评分显著低于对照组,差异有统计学意义(P0.05);观察组治疗7 d、14 d后的ADL评分显著高于对照组,差异有统计学意义(P0.05);观察组治疗7 d后P-selectin、CD62P、PAgT及PAdT显著低于对照组,差异有统计学意义(P0.05);两组不良反应总发生率比较,差异无统计学意义(P0.05)。结论 将替罗非班应用于急性进展性脑梗死患者治疗中可有效改善患者日常生活能力以及神经功能,对血小板活化有较强的抑制效果,且治疗安全性较高,有较高的临床应用价值。     

Preliminary experience with a high bolus dose of tirofiban during percutaneous coronary intervention

Summary

Background: In the TARGET study, sub-optimal platelet inhibition with tirofiban was held responsible for the higher incidence of periprocedural CK-MB release compared to abciximab. Since then, a new, higher bolus dose of tirofiban has been proposed to increase blood concentrations very soon after the start of treatment.

Objective: The aim of this study was to explore the bleeding risk and clinical outcome at 30 days in a series of patients undergoing percutaneous coronary intervention (PCI) with the new dosing regimen of tirofiban (25?μg/kg bolus followed by a 0.15?μgkg?1min?¹ infusion for 18?h).

Methods: A total of 133 consecutive patients underwent a PCI and received a high bolus dose of tirofiban. Platelet function inhibition was measured using the Ultegra? RPFA (Accumetrics) 10?min and 8 and 24?h after the start of therapy in the first 38 cases.

Results: The procedural success rate was 98.5%. The mean level of platelet inhibition 10?min after the start of therapy was 94.7?±?5.9%. No major bleedings, no need for red blood cell transfusion and no episodes of severe thrombocytopoeniawere recorded. Groin haematoma was observed in seven patients (5.3%). The cumulative incidence of 30-day major adverse cardiovascular events was 4.6% (five myocardial infarctions and one repeat PTCA for sub-acute stent thrombosis).

Conclusions: The use of a high bolus dose of tirofiban in patients undergoing PCI seems to be safe and not associated with an increased risk of major bleeding. This high bolus dose may help to further reduce the rate of periprocedural adverse events.     

Endovascular treatment with tirofiban during the acute stage of cervical spinal cord infarction due to vertebral artery dissection

Context: Cervical spinal cord infarction is a rare and severe complication of vertebral artery dissection (VAD). We report a case of VAD in an acute stage followed by cervical spinal cord infarction that was treated using direct endovascular tirofiban infusion via digital subtraction angiography (DSA) monitoring.

Findings: A 48-year-old man presented with vertigo, neck pain, numbness and weakness in four limbs with subsequent cardiac and respiratory arrest. Neurological examination revealed hypoesthesia below the neck with grade one myodynamia on the right side of the limbs and zero on the left side. The diagnosis of VAD-related cervical spinal infarction was confirmed using DSA imaging and cervical vertebra magnetic resonance imaging (MRI). The patient received timely treatment with endovascular tirofiban infusion and achieved good outcome without any sequelae.

Conclusion: Endovascular treatment with tirofiban may be a selective choice for cervical spinal cord infarction due to VAD in acute stage and warrants further study.     

替罗非班联合DAPT在急性心肌梗死行择期PCI患者中的应用效果

探讨替罗非班联合双联抗血小板治疗（DAPT）在急性心肌梗死（AMI）行择期经皮冠状动脉介入治疗（PCI）患者中的应用效果。方法 纳入2018年6月～2020年5月中国科学技术大学附属第一医院急诊科收治的72例行择期PCI的AMI患者,随机分为观察组（替罗非班联合DAPT,n=37）和对照组（普通DAPT,n=35）,统计比较两组患者的胸痛症状、围手术期出血率、心脏不良事件、冠脉TIMI血流分级、心脏射血分数（LVEF）。结果 观察组的无胸痛患者比率（94.6%）高于对照组（77.1%）,差异有统计学意义（P＜0.05）;围手术期观察组的出血率（5.4%）与对照组（5.7%）比较差异无统计学意义（P＞0.05）;观察组的心脏不良事件比率（108%）显著低于对照组（31.4%）,差异有统计学意义（P＜0.05）;支架释放前观察组获得血流TIMI3级人数占比（78.4%）与对照组（60.0%）比较,差异无统计学意义（P＞0.05）;支架释放后观察组获得血流TIMI3级人数占比（97.3%）与对照组（77.1%）对比,差异有统计学意义（P＜0.05）;PCI前在各罪犯血管分组中观察组和对照组的LVEF均无明显差异（P＞0.05）;PCI后在LAD组、LCX组中观察组的LVEF值高于对照组,差异有统计学意义（P＜0.05）,而在RCA组中两组LVEF无明显差异（P＞0.05）。结论 替罗非班不增加出血风险,联合DAPT能够恢复AMI患者冠脉血流、降低心脏事件发生率及改善心功能,应用于择期PCI的AMI患者有一定疗效。     

国产替罗非班治疗急性冠状动脉综合征的临床研究

目的在常规抗凝、抗血小板基础上,观察国产血小板膜糖蛋白Ⅱb/Ⅲa受体拮抗剂替罗非班治疗急性冠状动脉(冠脉)综合征的疗效和安全性。方法本试验为随机、双盲、安慰剂平行对照临床研究。符合急性冠脉综合征(不稳定型心绞痛/非Q波心肌梗死)入选标准患者62例,按就诊顺序双盲随机分为受试组(替罗非班,n=32)和对照组(n=30)。在均使用阿司匹林、氯吡格雷和肝素的基础上,试验组给予替罗非班(负荷量10μg/kg,在3min内推注),继以0.15μg/(kg.min)由微量泵持续泵入24~36h;对照组病例直接进行经皮冠状动脉介入治疗(PCI)。结果试验组30d内主要不良心脏事件(MACE,包括顽固性心绞痛/新发心肌梗死/死亡)发生率较对照组显著降低(9.3%比20.0%,P<0.05),心电图ST段下移程度和缺血导联数明显减少(P<0.05)。围术期出血并发症较对照组稍高,但差异无统计学意义。两组术后血小板计数、心功能(射血分数值)差异无统计学意义。结论国产替罗非班在急性冠脉综合征标准治疗基础上能进一步减少心肌缺血事件发生率,改善心电图心肌缺血改变,安全性好,但其长期疗效及毒副作用有待进一步观察。     

盐酸替罗非班对急诊经皮冠状动脉介入治疗无再流现象的影响

目的：观察盐酸替罗非班对ST段抬高急性心肌梗塞（STEMI）患者急诊经皮冠状动脉介入治疗（PCD中血流的影响。方法：一选择急诊入院STEMI患者43名，随机分为盐酸替罗非班组23例和对照组20例。替罗非班组PCI术前开始应用盐酸替罗非班，持续泵人至术后36-48h。对照组应用常规PCI。收集所有病例的临床及冠状动脉造影资料，观察PCI术前、术后血流情况。结果：替罗非班组急诊PCI术后TIMI血流3级的发生率（94％）较对照组（89％）显著增加（P〈0．05）。结论：替罗非班可改善STEMI患好梗塞相关血管的TIMI血流。     

替罗非班对急性心肌梗死急诊冠状动脉介入治疗冠状动脉血流和微循环的影响

目的分析应用替罗非班对ST段抬高性心肌梗死患者急诊行冠状动脉介入治疗冠状动脉血流和微循环的影响。方法ST段抬高性心肌梗死行直接冠状动脉介入治疗患者58例,随机分为替罗非班组(n=30)和对照组(n=28)。比较两组患者临床基础情况、冠状动脉介入治疗前梗死相关血管开通率、手术前后心肌梗死溶栓治疗血流情况、心电图ST段回落、术后内皮细胞凋亡数及凝血状态、住院期间出血事件、主要心脏不良事件发生率和出院前左心室射血分数等。结果替罗非班组使术前TIMI血流分级达到1级血流比例明显高于对照组(P<0.05),2级及3级血流两组之间差异无显著性(P>0.05),同时在对照组血流完全闭塞率高于替罗非班组(P<0.01),术中无复流现象、再灌注心律失常、内皮细胞凋亡数及凝血因子在替罗非班组均显著低于对照组(P<0.05),再通后90min心电图相关导联ST段回落值替罗非班组明显大于对照组(P<0.05),出院前左心室射血分数、两组患者主要心脏不良事件发生率和住院期间主要出血事件发生率差异无统计学意义(P>0.05)。结论替罗非班对急性ST段抬高性心肌梗死急诊行介入治疗可改善术前梗死相关血管TIMI血流情况,使介入手术顺利更好进行,争取更多时间避免较多的心肌细胞永久性坏死,改善心肌微循环障碍,减少无复流现象。     

替罗非班加药物洗脱支架治疗冠脉狭窄分叉病变的近期疗效观察

目的:探讨应用阿司匹林 氯吡格雷 替罗非班及药物洗脱支架(DES)治疗冠状动脉狭窄分叉病变的临床疗效。方法:回顾分析应用阿司匹林 氯吡格雷 替罗非班及DES治疗冠脉分叉病变56例的临床疗效。结果:56例冠脉分叉病变患者采用支架植入术,手术成功率达到100%,术中无急性血栓形成。临床随访1～2年无死亡和AMI发生。结论:本研究结果显示阿司匹林 氯吡格雷 替罗非班及DES治疗冠脉狭窄病变包括分叉病变的近期临床疗效十分满意。     

急性冠状动脉综合征介入并用替罗非班的近期疗效

目的评价急性冠状动脉综合征病人接受经皮冠状动脉介入术治疗中,使用国产血小板糖蛋白Ⅱb/Ⅲa(GPⅡb/Ⅲa)受体阻断药替罗非班(tirofiban)的近期疗效及安全性。方法急性冠状动脉综合征行介入治疗病人90例,分成替罗非班组及安慰剂组,替罗非班组剂量10μg/kg,在3min内静脉注入,然后以每分钟0.1μg/kg维持24～72h,随访30d,观察亚急性血栓形成、死亡、心肌梗死和紧急靶血管血运重建、出血等临床终点事件。结果两组临床、冠状动脉造影及介入治疗基线特征差异无统计学意义,替罗非班组及安慰剂组死亡、心肌梗死和紧急靶血管血运重建联合终点事件发生率,分别为2%和15%,差异有统计学意义(P<0.05)。两组病人主要、次要及轻微出血事件发生率差异无统计学意义。结论替罗非班可改善急性冠状动脉综合征行介入治疗病人的近期疗效,安全性相似,病人耐受性好。     

Tailoring Treatment with Tirofiban in Patients Showing Resistance to Aspirin and/or Resistance to Clopidogrel (3T/2R). Rationale for the Study and Protocol Design

PURPOSE: To assess whether glycoprotein IIb/IIIa inhibition using tirofiban in low risk patients undergoing percutaneous coronary intervention (PCI) may reduce the risk of periprocedural myocardial infarction compared to standard care in poor responders to aspirin and/or clopidogrel. METHODS: We will enroll patients at ten European sites or more to participate in the Tailoring Treatment with Tirofiban in patients showing Resistance to aspirin and/or Resistance to clopidogrel (3T/2R) study with a pre-specified sample size of 240 patients out of 1,100 or more who will undergo screening. The primary outcome measure is troponin I or T elevation ratio at least three times the upper limit of normal within 48 h after completion of the PCI. CONCLUSION: The results of 3T/2R study will evaluate whether tailored intensification of anti-platelet treatment based on poor individual response to oral anti-platelet agents may modulate the risk of periprocedural myocardial infarction during PCI. Our findings attempt at unraveling a new era of individualized anti-platelet treatment through the use of point-of-care assessment.