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CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY

Administration of abciximab to patients receiving tirofiban or eptifibatide: effect on platelet function

^a The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai School of Medicine, New York, New York, USA

Manuscript received March 13, 2000; revised manuscript received October 20, 2000, accepted November 22, 2000.

Reprint requests and correspondence: Dr. Jonathan D. Marmur, The Mount Sinai Medical Center, One Gustave Levy Place, Box 1030, New York, New York, 10029-6574
jonathan{at}marmur.com

OBJECTIVES

The goal of this study was to evaluate platelet function and to preliminarily assess the clinical safety of sequential treatment with tirofiban or eptifibatide followed by abciximab in patients undergoing percutaneous coronary intervention (PCI).

BACKGROUND

An increasing number of acute coronary syndrome (ACS) patients are treated early with tirofiban or eptifibatide. Some later require PCI and may benefit from switching to abciximab, for which long-term benefits have been reported.

METHODS

Fifty ACS patients planned for PCI were enrolled. Twenty-five patients received tirofiban followed by abciximab. Ten patients received eptifibatide followed by abciximab. Fifteen patients received only abciximab. All patients had blood samples drawn six times during the therapeutic course. Platelet function was evaluated by ADP- and TRAP-induced aggregation, flow cytometry analysis of fibrinogen binding and the cone and plate(let) analyzer, which tests shear rate-dependent platelet activation.

RESULTS

Administered after tirofiban, abciximab caused a significant further decline in platelet function, as evidenced by all methods. Administered after eptifibatide, abciximab caused a significant further reduction in platelet function, as assessed by the cone and plate(let) analyzer and fibrinogen binding methods. The platelet inhibition achieved by the combination therapy was always greater than or equal to that achieved by abciximab alone. There were no major bleeding or severe thrombocytopenia episodes. Three of the 35 combination therapy patients and one of the 15 who received abciximab alone had minor bleeding.

CONCLUSIONS

This is the first in vivo study of combination intravenous platelet glycoprotein IIb/IIIa inhibitor therapy. Administration of abciximab immediately after tirofiban or eptifibatide therapy effectively inhibits platelet function and appears to be safe.

Abbreviations and Acronyms   ACS = acute coronary syndrome   CPA = cone and plate(let) analyzer   GP = platelet glycoprotein   MI = myocardial infarction   NS = nonsignificant   PCI = percutaneous coronary intervention   PPACK = D-Phe-Pro-Arg chloromethyl ketone dihydrochloride   PRP = platelet rich plasma   TRAP = thrombin receptor activating peptide

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