Platelet Inhibition by Abciximab Bolus-Only Administration and Oral ADP Receptor Antagonist Loading in Acute Coronary Syndrome Patients: The Blocking and Bridging Strategy |
| |
Authors: | Gü nter Christ,Thomas Hafner,Jolanta M. Siller-Matula,Marcel Francesconi,Katharina Grohs,Eva Wilhelm,Andrea Podczeck-Schweighofer |
| |
Affiliation: | 1. 5th Medical Department with Cardiology, Kaiser Franz Josef Hospital, Vienna, Austria;2. Department of Cardiology, Medical University of Vienna, Austria;3. Clinical Institute for Laboratory Medicine, Kaiser Franz Josef Hospital, Vienna, Austria |
| |
Abstract: | IntroductionCurrent 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.Patients and methodsFifty-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.ResultsThrombin receptor-activating peptide induced platelet aggregation was significantly suppressed for a minimum of 48 h (45 ± 17 U) and returned to a normal range (> 84 U) after 6 days (90 ± 26 U; p < 0.001). 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.ConclusionsImmediate 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. |
| |
Keywords: | ACS, acute coronary syndrome ADP, adenosine diphosphate GPI, glycoprotein IIb/IIIa receptor inhibitor MEA, multiple electrode aggregometry NSTEMI, Non-ST-elevation myocardial infarction PCI, percutaneous coronary intervention STEMI, ST-elevation myocardial infarction TRAP, Thrombin receptor-activating peptide |
本文献已被 ScienceDirect 等数据库收录! |
|