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Abciximab reduces mortality in diabetics following percutaneous coronary intervention

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第4期35卷 922-928页

作者： Bhatt, DL Marso, SP Lincoff, AM Wolski, KE Ellis, SG Topol, EJ Cleveland Clin Fdn Dept Cardiol Cleveland OH 44195 USA

OBJECTIVES We sought to determine whether abciximab therapy at the time of percutaneous coronary intervention (PCI) would favorably affect one-year mortality in patients with diabetes. BACKGROUND Diabetics are known to have increased late mortality following PCI. METHODS Data from three placebo-controlled trials of PCI, EPIC, EPILOG, and EPISTENT, were pooled. The one-year mortality rate for patients with a clinical diagnosis of diabetes mellitus was compared with the rate for nondiabetic patients treated with either abciximab or placebo. RESULTS In the 1,462 diabetic patients, abciximab decreased the mortality from 4.5% to 2.5%, p = 0.031, and in the 5,072 nondiabetic patients, from 2.6% to 1.9%, p = 0.099. In patients with the clinical syndrome of insulin resistance-defined as diabetes, hypertension, and obesity-mortality was reduced by abciximab treatment from 5.1% to 2.3%, p = 0.044. The beneficial reduction in mortality with abciximab use in diabetics classified as insulin-requiring was from 8.1% to 4.2%, p = 0.073. Mortality in diabetics who underwent multivessel intervention was reduced from 7.7% to 0.9% with use of abciximab, p = 0.018. In a Cox proportional hazards survival model, the risk ratio for mortality with abciximab use compared with placebo was 0.642 (95% confidence interval 0.458-0.900, p = 0.010). CONCLUSIONS Abciximab decreases the mortality of diabetic patients to the level of placebo-treated nondiabetic patients. This beneficial effect is noteworthy in those diabetic patients who are also hypertensive and obese and in diabetics undergoing multivessel intervention. Besides its potential role in reducing repeat intervention for stented diabetic patients, abciximab therapy should be strongly considered in diabetic patients undergoing PCI to improve their survival. (C) 2000 by the American College of Cardiology.

关键词：心绞痛不稳定型/死亡率心绞痛不稳定型/治疗血管成形术气囊冠状动脉抗体单克隆/副作用抗体单克隆/治疗应用糖尿病血管病变/死亡率糖尿病血管病变/治疗剂量效应关系药物用药计划表随访研究免疫球蛋白Fab片段/副作用免疫球蛋白Fab片段/治疗应用心肌梗死/死亡率心肌梗死/治疗血小板聚集抑制剂/副作用血小板聚集抑制剂/治疗应用血小板糖蛋白GPⅡb-Ⅲa复合物/拮抗剂和抑制剂随机对照试验(主题) 复发危险因素支架存活率成年人老年人女(雌)性人类男(雄)性中年人

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Occurrence and clinical significance of pseudothrombocytopenia during abciximab therapy

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第1期36卷 75-83页

作者： Sane, DC Damaraju, LV Topol, EJ Cabot, CF Mascelli, MA Harrington, RA Simoons, ML Califf, RM Wake Forest Univ Bowman Gray Sch Med Cardiol Sect Winston Salem NC 27157 USA Centocor Inc Malvern PA 19355 USA Cleveland Clin Fdn Cleveland OH 44195 USA Univ Rotterdam Hosp Thoraxctr Rotterdam Netherlands Duke Univ Med Ctr Durham NC USA

OBJECTIVES This study determined the incidence of pseudothrombocytopenia during abciximab therapy administered for percutaneous coronary interventions and compared the clinical course of patients with pseudothrombocytopenia with the clinical courses of patients with thrombocytopenia and patients with normal platelet counts. BACKGROUND Although pseudothrombocytopenia has been previously reported during therapy with abciximab, the incidence and significance of this occurrence are unknown. The failure to differentiate pseudothrombocytopenia from thrombocytopenia could lead to unnecessary interruption of abciximab infusions or to platelet transfusions. METHODS The incidences of pseudothrombocytopenia and thrombocytopenia were determined in four large placebo-controlled abciximab trials: c7E3 Fab Antiplatelet Therapy in Unstable Refractory Angina (CAPTURE), Evaluation of 7E3 for the Prevention of Ischemic Complications (EPIC), Evaluation of Percutaneous Transluminal Coronary Angioplasty to Improve Long-term Outcome of c7E3 GpIIb/lIIa Receptor Blockade (EPILOG) and Evaluation of Platelet IIb/IIIa Inhibitor for Stenting (EPISTENT). The clinical features, bleeding complications and major clinical outcomes of patients with pseudothrombocytopenia and those with thrombocytopenia were compared with each other and with those of patients with normal platelet count. RESULTS Pseudothrombocytopenia occurred in 2.1% (95% confidence intervals [CI]: 1.7%, 2.5%) of of abciximab-treated patients and in 0.6% of placebo-treated patients (p < 0.001). Thrombocytopenia occurred in 3.7% (95% CI: 3.2%, 4.2%) of abciximab-treated patients and in 1.8% (95% CI: 1.3%, 2.3%) of placebo-treated patients (p < 0.001). Patients with thrombocytopenia had significantly higher rates of major bleeding, major decreases in hemoglobin and increased transfusion requirements of both blood and platelets compared with those without thrombocytopenia. By contrast, pseudothrombocytopenic patients did not differ from

关键词：心绞痛不稳定型/血液心绞痛不稳定型/药物疗法心绞痛不稳定型/外科学抗体单克隆/投药和剂量抗体单克隆/副作用置信区间冠状动脉分流术诊断鉴别双盲法免疫球蛋白Fab片段/投药和剂量免疫球蛋白Fab片段/副作用发病率输注静脉内血小板聚集抑制剂/投药和剂量血小板聚集抑制剂/副作用血小板计数/药物作用血小板糖蛋白GPⅡb-Ⅲa复合物/拮抗剂和抑制剂前瞻性研究血小板减少/血液血小板减少/化学诱导血小板减少/诊断老年人女(雌)性人类男(雄)性中年人

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Abciximab in the treatment of acute myocardial infarction eligible for primary percutaneous transluminal coronary angioplasty -: Results of the glycoprotein receptor antagonist patency evaluation (GRAPE) pilot study

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 1999年第6期33卷 1528-1532页

作者： van den Merkhof, LFM Zijlstra, F Olsson, H Grip, L Veen, G Bär, FWHM van den Brand, MJBM Simoons, ML Verheugt, FWA Univ Nijmegen Hosp Heartctr Dept Cardiol NL-6500 HB Nijmegen Netherlands Weezenlanden Hosp Zwolle Netherlands Orebro Med Ctr Hosp S-70185 Orebro Sweden Sahlgrens Univ Hosp S-41345 Gothenburg Sweden Free Univ Amsterdam Hosp Amsterdam Netherlands Univ Hosp Maastricht Maastricht Netherlands Univ Rotterdam Hosp Thoraxctr Rotterdam Netherlands

OBJECTIVES We sought to study the effect of early infusion of abciximab on coronary patency before primary angioplasty in patients with acute myocardial infarction. BACKGROUND Glycoprotein IIb/IIIa antagonists have proved to be effective in reducing ischemic events associated with coronary angioplasty. The present study explores whether abciximab alone, without administration of thrombolytic therapy, may induct reperfusion in patients with acute myocardial infarction. METHODS In the Glycoprotein Receptor Antagonist Patency Evaluation pilot study 60 patients with less than 6 h signs and symptoms of acute myocardial infarction eligible for primary angioplasty received in the emergency room a bolus of abciximab 250 mu g/kg followed by a 12-h infusion of 10 mu g/min. All patients were also treated with an oral dose of 160 mg aspirin and 5,000 IU of heparin intravenously, As soon as possible a diagnostic angiography was performed to evaluate the patency of the infarct-related artery. RESULTS The median time between onset of symptoms and the administration of the abciximab bolus was 150 min (range 45 to 345), and the median time between abciximab bolus and first contrast injection in the infarct-related artery was 45 min (range 10 to 150). In 24 patients (40%, 95% confidence interval 28% to 52%) Thrombolysis in Myocardial Infarction (TIMI) flow grade 2 or 3 was observed at a median time of 45 min (range 10 to 150) after abciximab bolus;TIMI flow grade 3 was observed in 11 patients (18%, 95% confidence interval 9% to 28%). There was no difference fn percentage of TIMI flow grade 2 or 3 between patients who received abciximab within 2.5 h after onset of symptoms or thereafter. CONCLUSIONS Abciximab therapy given in the emergency room in patients awaiting primary angioplasty is associated with full reperfusion (TIMI flow grade 3) in about 20% and with TIMI flow grade 2 of 3 in about 40% of the patients at a median time of 45 min. These figures are higher than those in primar

关键词：血管成形术气囊冠状动脉抗体单克隆/投药和剂量抗体单克隆/副作用阿司匹林/投药和剂量阿司匹林/副作用冠状动脉循环/药物作用剂量效应关系药物用药计划表药物疗法联合肝素/投药和剂量肝素/副作用免疫球蛋白Fab片段/投药和剂量免疫球蛋白Fab片段/副作用输注静脉内心肌梗死/治疗试点项目血小板聚集抑制剂/投药和剂量血小板聚集抑制剂/副作用术前用药法成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Rapid improvement of psoriasis vulgaris during drug-induced agranulocytosis

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JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY 2000年第2期43卷 391-395页

作者： Toichi, E Tachibana, T Furukawa, F Kyoto Univ Grad Sch Med Dept Dermatol Sakyo Ku Kyoto 6068507 Japan Wakayama Med Coll Wakayama Japan

The role of neutrophils in psoriasis has long been discussed. We report a patient with long-standing psoriasis vulgaris who showed rapid improvement during agranulocytosis caused by ticlopidine. The patient did not develop any new psoriatic lesions for several days, although neutrophils increased daily after the administration of ticlopidine was stopped. The day after the peripheral blood neutrophil count recovered, several psoriatic plaques reappeared. The correlation of psoriatic activity with peripheral blood neutrophil counts suggests that a certain number of neutrophils may be required to initiate and maintain psoriasis.

关键词：粒细胞缺乏/化学诱导粒细胞缺乏/免疫学粒细胞缺乏/病理学活组织检查大脑梗死/药物疗法白细胞计数中性白细胞/药物作用中性白细胞/免疫学血小板聚集抑制剂/副作用血小板聚集抑制剂/治疗应用银屑病/免疫学银屑病/病理学缓解自行皮肤/病理学噻氯匹定/副作用噻氯匹定/治疗应用老年人人类男(雄)性

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Comparison of eptifibatide and abciximab with decision analysis

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AMERICAN JOURNAL OF HEALTH-SYSTEM PHARMACY 2001年第15期58卷 1432-1436页

作者： Wong, DH Methodist Hosp So Calif Dept Pharm Serv Arcadia CA 91007 USA

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Unprotected left main coronary artery stenting: Immediate and medium-term outcomes of 140 elective procedures

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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY 2000年第6期35卷 1543-1550页

作者： Silvestri, M Barragan, P Sainsous, J Bayet, G Simeoni, LB Roquebert, PO Macaluso, G Bouvier, JL Comet, B Beauregard Private Hosp Dept Cardiol Marseille France

OBJECTIVES We sought to evaluate immediate and late outcomes after stenting for left main coronary artery (LMCA) stenosis. BACKGROUND Conventional percutaneous transluminal coronary angioplasty (PTCA), for which coronary artery bypass grafting (CABG) has been the gold standard therapy for years, has yielded poor results in unprotected LMCA lesions. The development of coronary stents, together with their dramatic patency improvement provided by new antiplatelet regimens and their validation against restenosis, warrants a reappraisal of angioplasty in LMCA stenosis. METHODS From January 1993 to September 1998, 140 consecutive unselected patients with unprotected LMCA stenosis underwent elective stenting. Group I included 47 high-CABG-risk patients, and group II included 93 low-CABG-risk patients. Ticlopidine without aspirin was routinely started at least 72 h before the procedure and continued for one month. Patients were reevaluated monthly. A follow-up angiography was requested after six months. RESULTS The procedure success rate was 100%. One-month mortality was 9% (4/47) in group I and 0% in group II. A follow-up angiography nas obtained in 82% of cases, and target lesion revascularization was required in 17.4%. One-year actuarial survival was 89% in the first 29 group I patients and 97.5% in the first 63 group IT patients. CONCLUSIONS Stenting of unprotected LMCA stenosis provided excellent immediate results, particularly in good CABG candidates. Medium-term results were good, with a restenosis rate of 23%, similar to that seen after stenting at other coronary sites. Stenting deserves to be considered a safe and effective alternative to CABG in institutions performing large numbers of PTCAs. (C) 2000 by the American College of Cardiology.

关键词：血管成形术气囊冠状动脉/仪器和设备冠状血管造影术冠心病/诊断显像冠心病/死亡率冠心病/治疗随访研究血小板聚集抑制剂/投药和剂量血小板聚集抑制剂/副作用术前用药法支架存活率噻氯匹定/投药和剂量噻氯匹定/副作用治疗结果成年人老年人老年人 80以上女(雌)性人类男(雄)性中年人

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Safety of abciximab in patients with chronic renal insufficiency who are undergoing percutaneous coronary interventions

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AMERICAN HEART JOURNAL 2003年第2期146卷 345-350页

作者： Best, PJM Lennon, R Gersh, BJ Ting, HH Rihal, CS Bell, MR Herzog, CA Holmes, DR Berger, PB Mayo Clin & Mayo Fdn Dept Internal Med Div Cardiovasc Dis Rochester MN 55905 USA Mayo Clin & Mayo Fdn Div Biostat Rochester MN 55905 USA Hennepin Cty Med Ctr Dept Internal Med Div Cardiol Minneapolis MN 55415 USA

Background Patients with chronic renal insufficiency (CRI) have worse outcomes during and after percutaneous coronary interventions (PCI). Abciximab reduces complications, but may cause excessive bleeding in patients with CRI. Therefore, we sought to determine the safety of abciximab in patients with CRI. Methods Patients (n = 4158) undergoing PCI at the Mayo Clinic since abciximab became available were analyzed according to their estimated creatinine clearance ( greater than or equal to70, 50-69, or <50 mL/min) or need for dialysis. Major bleeding was defined as a cerebrovascular bleed or a decrease in the hematocrit level > 15%. Minor bleeding was defined as a decrease in the hematocrit level of 10% to 15% with an identifiable site of bleeding. Results CRI was associated with increased bleeding in patients who received abciximab and patients who did not. However, there was only a trend toward an interaction between creatinine clearance and major bleeding with abciximab (odds ratio [OR], 1.18;P =.06) and no interaction with minor bleeding (OR, 1.01;P =.94) or, any bleeding (OR, 1.10;P =.15). Conclusion CRI is associated with an increased risk of bleeding complications after PCI. Although abciximab increases the risk of bleeding in all patients, the increase in relative risk is not significantly greater in patients with CRI. Thus, abciximab may be given safely in patients with CRI who are undergoing PCI.

关键词：方差分析血管成形术气囊冠状动脉抗体单克隆/副作用抗体单克隆/治疗应用冠状血管造影术冠心病/并发症冠心病/治疗肌酸酐/代谢随访研究出血/化学诱导出血/流行病学免疫球蛋白Fab片段/副作用免疫球蛋白Fab片段/治疗应用肾功能衰竭慢性/血液肾功能衰竭慢性/并发症 Logistic模型血小板聚集抑制剂/副作用血小板聚集抑制剂/治疗应用危险老年人女(雌)性人类男(雄)性中年人

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The Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) study: To what extent should the results be generalizable?

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AMERICAN HEART JOURNAL 2003年第4期145卷 595-601页

作者： Gerschutz, GP Bhatt, DL Cleveland Clin Fdn Dept Cardiol Cleveland OH 44195 USA

The Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) study investigated the use of clopidogrel in the treatment of acute coronary syndromes. Clopidogrel treatment led to an impressive 20% relative risk reduction in the composite outcome measure of vascular death, myocardial infarction, and stroke. Increased bleeding and greater requirements for blood transfusions were seen with clopidogrel. The addition-of clopidogrel to aspirin represents a major advance in the treatment of acute coronary syndromes.

关键词：心绞痛不稳定型/并发症阿司匹林/治疗应用冠心病/并发症冠心病/预防和控制双盲法心力衰竭/并发症出血/化学诱导血小板聚集抑制剂/副作用血小板聚集抑制剂/治疗应用复发支架/副作用卒中/预防和控制血栓形成/预防和控制噻氯匹定/副作用噻氯匹定/类似物和衍生物噻氯匹定/治疗应用女(雌)性人类男(雄)性中年人

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阿司匹林与氯吡格雷疗效及不良反应的药物基因组学研究进展

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中国医师杂志 2015年第1期17卷 153-155页

作者：陶然黄红光南华大学湖南省衡阳421001 长沙市中心医院心内科

在临床实践中，阿司匹林和氯吡格雷作为抗血小板药物常常被用于降低缺血性事件的复发，但在治疗中药物并不是总能达到预期治疗效果，甚至产生多种不良药物反应，许多研究表明个体的基因型决定了药物产生的疗效和毒性，在当中占据最重要... 详细信息

在临床实践中，阿司匹林和氯吡格雷作为抗血小板药物常常被用于降低缺血性事件的复发，但在治疗中药物并不是总能达到预期治疗效果，甚至产生多种不良药物反应，许多研究表明个体的基因型决定了药物产生的疗效和毒性，在当中占据最重要地位的是药物相关基因多态性，以基因型指导药物种类及剂量的选择，可以达到疗效最大化而不良反应最小化，减轻患者的痛苦和经济负担的目的。

关键词：阿司匹林/治疗应用血小板聚集抑制剂/治疗应用阿司匹林/副作用血小板聚集抑制剂/副作用遗传药理学综述

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Cilostazol.

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American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists 2002年第3期59卷 243-244页

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