Long-Term Clinical Outcomes of Platelet Glycoprotein IIb/IIIa Inhibitor Combined With Low Molecular Weight Heparin in Patients With Acute Coronary Syndrome

• Published in: Circulation Journal 2005, Vol.69(2), pp.159-164
• Main Authors: Kim, Ju Han, Jeong, Myung Ho, Rhew, Jay Young, Lim, Ji Hyun, Yun, Kyung Ho, Kim, Kye Hun, Kang, Dong Koo, Hong, Seo Na, Lim, Sang Yup, Lee, Sang Hyun, Lee, Yeon Sang, Hong, Young Joon, Park, Hyung Wook, Kim, Weon, Ahn, Young Keun, Moon, Yong, Cho, Jeong Gwang, Park, Jong Chun, Kang, Jung Chaee
• Format: Article
• Language: English
• Subjects: Acute Disease; Aged; Coronary disease; Coronary Disease - drug therapy; Coronary Disease - prevention & control; Dalteparin - adverse effects; Dalteparin - therapeutic use; Drug Therapy, Combination; Female; Hemorrhage - chemically induced; Heparin; Heparin - adverse effects; Heparin - therapeutic use; Heparin, Low-Molecular-Weight - therapeutic use; Humans; Male; Middle Aged; Platelet aggregation inhibitors; Platelet Aggregation Inhibitors - adverse effects; Platelet Aggregation Inhibitors - therapeutic use; Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors; Tirofiban; Treatment Outcome; Tyrosine - adverse effects; Tyrosine - analogs & derivatives; Tyrosine - therapeutic use
• ISSN: 1346-9843; 1347-4820
• DOI: 10.1253/circj.69.159

Background Platelet activation and aggregation with resultant arterial thrombus formation play a pivotal role in the pathophysiology of acute coronary syndrome (ACS). In the present study the efficacy of tirofiban, a specific inhibitor of the platelet glycoprotein IIb/IIIa receptor, combined with heparin or low-molecular-weight heparin (dalteparin), was evaluated for the management of ACS. Methods and Results One hundred and sixty patients (60.9±11.1 years, 104 male) with unstable angina or non-ST elevation myocardial infarction and who had ST-T changes and elevated troponin were randomly assigned to 4 groups: group I (n=40: heparin alone), group II (n=40: dalteparin alone), group III (n=40: tirofiban + heparin) and group IV (n=40: tirofiban + dalteparin). The occurrence of major adverse cardiac events (MACE) was compared prospectively during a 6-month clinical follow-up. Percutaneous coronary intervention or coronary artery bypass graft was performed in 32 cases in group I, 29 in group II, 28 in group III and 31 in group IV (p=0.72). Minor bleeding complication developed in 2 patients (5.0%) in group I, 2 (5.0%) in group II, 4 (10.0%) in group III and 3 (7.5%) in group IV (p=0.78). During the follow-up MACE occurred in 10 patients (31.3%) in group I, 9 (31.0%) in group II, 4 (14.3%) in group III and 4 (12.9%) in group IV (p=0.02: Group I and II vs Group III and IV). Conclusions Tirofiban combined with dalteparin was associated with relatively more bleeding complications in the short term, but was effective in reducing the incidence of MACE during long-term clinical follow-up in patients with ACS. (Circ J 2005; 69: 159 - 164)