Therapeutic Use of Intravenous Eptifibatide in Patients Undergoing Percutaneous Coronary Intervention
Therapeutic Use of Intravenous Eptifibatide in Patients Undergoing Percutaneous Coronary Intervention
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静脉注射依替巴肽在经皮冠状动脉介入治疗患者中的治疗用途
DOI：
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发表时间：
2004
影响因子：
3
通讯作者：
N. Kleiman
中科院分区：
文献类型：
--
作者：
J. Granada;N. Kleiman
Eptifibatide是一种从东南部侏儒响尾蛇毒液中分离出来的分子，可选择性抑制血小板受体IIb/IIIa。依替巴肽在接受经皮冠状动脉介入治疗（PCI）的患者中的安全性和临床疗效首次在Integrilin最小化血小板聚集和冠状动脉血栓形成（IMPACT）试验中进行了评价。在本研究中，主要联合终点（30天时死亡、心肌梗死[MI]或靶血管血运重建[TVR]的复合终点）发生在9.6%的依替巴肽推注后4小时输注组患者中，而安慰剂组为12.2%（p = 0.67）。在IMPACT-II试验中，在4011例接受择期PCI的患者中研究了两种不同的依替巴肽剂量。主要终点（30天时死亡、MI、TVR或因血管闭塞威胁而置入支架）的发生率在安慰剂组为11.6%，在135/0.5依替巴肽组为9.1%（p = 0.035），在135/0.75依替巴肽组为10%（p = 0.18）。整合素治疗增强血小板IIb/IIIa受体抑制（ESPRIT）试验研究了在接受非紧急冠状动脉支架植入术（两次180 μg/kg推注给药，间隔10分钟）的患者中使用的依替巴肽剂量比IMPACT II试验中使用的剂量高3- 4倍。安慰剂组有18.3%的患者发生6个月复合终点（死亡、心肌梗死、TVR和“救助”使用依替巴肽），而依替巴肽组有14.2%的患者发生（p = 0.008），并在12个月时保持不变（安慰剂组为22.1%，依替巴肽组为17.5%，p = 0.0068）。不稳定型心绞痛患者血小板糖蛋白IIb/IIIa的变化应用整合素受体抑制疗法（PURSUIT）研究10948例急性冠脉综合征（ACS）患者，观察两种不同剂量的依替巴肽治疗ACS的疗效（180 μg/kg推注，随后以1.3 μg/kg/min或2 μg/kg/min输注。主要终点，30天时死亡或MI的复合终点，15.7%的安慰剂治疗患者和14.2%的依替巴肽治疗患者发生（p = 0.042）。这种差异在第7天（安慰剂组11.6% vs依替巴肽组10.1%，p = 0.016）和第30天（安慰剂组15.7% vs依替巴肽组14.2%）保持不变。在依替巴肽研究中，ESPRIT组和PURSUIT组的大出血发生率分别为0.7%（对照组为0.5%）和2.1%（安慰剂组为1.3%）。ESPRIT组的颅内出血发生率为0.2%（安慰剂组为0.1%），PURSUIT组为0.7%（安慰剂组为0.8%）。ESPRIT试验中0.2%接受依替巴肽治疗的患者（安慰剂组为0%）和PURSUIT中<1%（安慰剂组<1%）报告了显著的血小板减少症（血小板计数<20 000/μL）。总之，几项临床试验表明，在PCI期间接受依替巴肽作为连续药物治疗的患者中，各种缺血事件明显减少。
Eptifibatide, a molecule isolated from the venom of the southeastern pygmy rattlesnake, selectively inhibits the platelet receptor IIb/IIIa. The safety and clinical efficacy of eptifibatide in patients undergoing percutaneous coronary intervention (PCI) was first evaluated in the Integrilin to Minimize Platelet Aggregation and Coronary Thrombosis (IMPACT) trial. In this study, the primary combined endpoint (composite of death, myocardial infarction [MI] or target vessel revascularization [TVR] at 30 days) occurred in 9.6% of the patients assigned to eptifibatide bolus followed by the 4-hour infusion versus 12.2% in the placebo group (p = 0.67). In the IMPACT-II trial, two different eptifibatide dosages were studied in 4011 patients undergoing elective PCI. The primary endpoint (death, MI, TVR or stent placement for threatened vessel closure at 30 days) occurred in 11.6% in the placebo group versus 9.1% in the 135/0.5 eptifibatide group (p = 0.035) and 10% in the 135/0.75 eptifibatide group (p = 0.18). The Enhanced Suppression of Platelet IIb/IIIa Receptor with Integrilin Therapy (ESPRIT) trial studied a dose of eptifibatide 3- to 4-fold higher than that used in IMPACT II trial in patients undergoing non-emergent coronary artery stenting (two 180 μg/kg bolus doses 10 minutes apart). The 6-month composite endpoint (death, MI, TVR and ‘bailout’ eptifibatide use) occurred in 18.3% of patients in the placebo group versus 14.2% in the eptifibatide group (p = 0.008) and was maintained at 12 months (22.1% in the placebo group vs 17.5% in the eptifibatide group, p = 0.0068). The Platelet Glycoprotein IIb/IIIa in Unstable Angina: Receptor Suppression Using Integrilin Therapy (PURSUIT) study in 10 948 patients was designed to study the effect of eptifibatide in the treatment of acute coronary syndromes (ACS) using two different dosages (180 μg/kg bolus followed by an infusion of either 1.3 μg/kg/min or 2 μg/kg/min. The primary endpoint, a composite of death or MI at 30 days, occurred in 15.7% of placebo-treated patients and 14.2% of eptifibatide-treated patients (p = 0.042). This difference was maintained at 7 days (11.6% in the placebo group vs 10.1% in the eptifibatide group, p = 0.016) and at 30 days (15.7% in the placebo group vs 14.2% in the eptifibatide group). In the eptifibatide studies, the rates of major bleeding were 0.7% (0.5% in the control group) in ESPRIT and 2.1% (1.3% in the placebo group) in PURSUIT. The incidence of intracranial bleeding was 0.2% in ESPRIT (0.1% in the placebo group) and 0.7% in PURSUIT (0.8% in the placebo group). Significant thrombocytopenia (platelet count <20 000/μL) was reported in 0.2% of the patients receiving eptifibatide in the ESPRIT trial (0% in the placebo group) and in <1% in PURSUIT (<1% in the placebo group). In summary, several clinical trials have demonstrated a clear-cut reduction in a variety of ischemic events in patients receiving eptifibatide as adjunctive pharmacotherapy during PCI.
影响因子：
37.8
作者：
COLLER, BS;FOLTS, JD;JORDAN, R
通讯作者：
JORDAN, R
在犬制剂中联合推注重组组织型纤溶酶原激活剂和单克隆抗血小板 GPIIb/IIIa 抗体，可快速、持续地实现冠状动脉再通。
影响因子：
37.8
作者：
Gold,HK;Coller,BS;Yasuda,T;Saito,T;Fallon,JT;Guerrero,JL;Leinbach,RC;Ziskind,AA;Collen,D
通讯作者：
Collen,D