High-dose tirofiban with enoxaparin and inflammatory markers in high-risk percutaneous intervention

Eur J Clin Invest. 2010 Feb;40(2):139-47. doi: 10.1111/j.1365-2362.2009.02237.x. Epub 2009 Dec 21.

Abstract

Aim: The study assessed the benefit of high bolus dose tirofiban (HD-tirofiban) with enoxaparin compared with HD-tirofiban with unfractionated heparin (UFH). The study examined markers of platelet activation, thrombin generation and inflammation.

Materials and methods: The study is a prospective single centre open-label trial of patients with high-risk acute coronary syndrome treated with percutaneous intervention (PCI) who were randomized to anticoagulation with UFH or enoxaparin with HD-tirofiban (25 microg kg(-1) bolus). This study measured a panel of platelet activation markers, inflammatory biomarkers and thrombus generation between the two groups.

Result: Sixty patients undergoing high-risk PCI were enroled in the study. Platelet inhibition as assessed by whole blood aggregometry following HD-tirofiban infusion was similar in both the UFH and enoxaparin groups. CD40 ligand expression on platelets was significantly reduced following PCI with HD-tirofiban and either UFH or enoxaparin. Following PCI, there were significant reductions measured in other markers of platelet activation including PAC-1, P selectin, factor V/Va, platelet-monocyte aggregates and monocyte expression of Mac-1 as determined by analysis of venous blood samples using flow cytometry. Prothrombin fragment 1+2, D-dimer, von Willebrand factor and high sensitive C-reactive protein levels were significantly less post PCI in the enoxaparin group compared with those patients receiving UFH.

Conclusion: The combination of HD tirofiban with enoxaparin resulted in an attenuated inflammatory response when compared with that of the combination of HD tirofiban with UFH.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / blood
  • Acute Coronary Syndrome / drug therapy*
  • Acute Coronary Syndrome / immunology
  • Acute Coronary Syndrome / therapy
  • Aged
  • Angioplasty, Balloon
  • Anticoagulants / pharmacology*
  • Biomarkers / blood
  • Blood Coagulation Factors / analysis
  • Blood Platelets / immunology
  • CD40 Ligand / metabolism*
  • Enoxaparin / administration & dosage
  • Enoxaparin / pharmacology*
  • Female
  • Flow Cytometry
  • Heparin / administration & dosage
  • Heparin / pharmacology*
  • Humans
  • Inflammation / immunology
  • Male
  • Middle Aged
  • Platelet Activation / drug effects*
  • Platelet Aggregation Inhibitors / pharmacology*
  • Prospective Studies
  • Tirofiban
  • Tyrosine / administration & dosage
  • Tyrosine / analogs & derivatives*
  • Tyrosine / pharmacology

Substances

  • Anticoagulants
  • Biomarkers
  • Blood Coagulation Factors
  • Enoxaparin
  • Platelet Aggregation Inhibitors
  • CD40 Ligand
  • Tyrosine
  • Heparin
  • Tirofiban