CLINICAL STUDY: INTERVENTIONAL CARDIOLOGY
Antiplatelet effects of abciximab, tirofiban and eptifibatide in patients undergoing coronary stenting
Franz-Josef Neumann, MDa,
Willibald Hochholzera,
Gisela Pogatsa-Murray, MDa,
Albert Schömig, MDa and
Meinrad Gawaz, MDa
a Medizinische Klinik and Deutsches Herzzentrum, Technische Universität München, Munich, Germany. This study was supported in part by grants from MSD Sharp & Dohme, Haar, Germany, and from Accumetrics, San Diego, California
Manuscript received June 26, 2000;
revised manuscript received December 13, 2000,
accepted January 4, 2001.
Reprint requests and correspondence: Dr. Franz-Josef Neumann, Medizinische Klinik der Technischen Universität, Ismaningerstrasse 22, 81674 Munich, Germany
neumann{at}dhm.mhn.de
OBJECTIVES
We sought to investigate whether abciximab, tirofiban and eptifibatide achieve comparable antiplatelet effects with coronary stenting.
BACKGROUND
The glycoprotein (GP) IIb/IIIa antagonists abciximab, tirofiban and eptifibatide differ in chemical structure, binding site and pharmacokinetics.
METHODS
Sixty patients undergoing coronary stenting were randomly assigned to abciximab (bolus 0.25 mg/kg body weight, infusion 10 µg per min for 12 h), tirofiban (bolus 10 µg/kg, infusion 0.15 µg/kg per min for 72 h) or eptifibatide (bolus 180 µg/kg, infusion 2 µg/kg per min for 72 h). We took serial blood samples to analyze platelet function by using flow cytometry, turbidimetric aggregometry and the rapid platelet-function assay (RPFA).
RESULTS
As assessed by RPFA, platelet aggregation after 2 h of infusion was reduced to 5.9 ± 7.8% (mean ± SD) of baseline by abciximab, to 5.0 ± 5.4% by tirofiban and to 7.8 ± 7.1% by eptifibatide (p = 0.42). Turbidimetric aggregometry with adenosine diphosphate stimulation yielded similar results, whereas percent inhibition of platelet aggregation after thrombin receptor stimulation was 45.8 ± 16.8% with abciximab, 51.3 ± 17.6% with tirofiban and 52.9 ± 14.8% with eptifibatide (p = 0.37). Tirofiban and eptifibatide maintained their level of platelet inhibition during infusion. Flow cytometry revealed that the reduction in the monocyte-platelet interaction by abciximab, tirofiban and eptifibatide was not significantly different (20.0 ± 21.9%, 23.8 ± 18.2% and 21.0 ± 19.8%, respectively; p = 0.87).
CONCLUSIONS
Abciximab, tirofiban and eptifibatide, at currently recommended doses, achieved similar levels of inhibition of platelet aggregation and a similar reduction in the platelet–monocyte interaction.
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Abbreviations and Acronyms
| | ADP | = adenosine diphosphate | | FITC | = fluorescein isothiocyanate | | GP | = glycoprotein | | mAB | = monoclonal antibody | | PE | = phycoerythrin | | RPFA | = rapid platelet-function assay | | TRAP | = thrombin receptor activating peptide |
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