| Defining the role of platelet glycoprotein receptor inhibitors in STEMI: focus on tirofiban. | |
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MedLine Citation:
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PMID: 19192938 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Tirofiban is a small molecule, nonpeptide tyrosine derivative. Although similar to abciximab in that it has a high specificity and affinity for the glycoprotein (GP) IIb/IIIa receptor, tirofiban dissociates from the GP IIb/IIIa receptor more rapidly than abciximab. Additionally, the action of tirofiban is reversed within hours after completion of the infusion, whereas abciximab binds irreversibly resulting in a considerably longer effect. The efficacy of tirofiban in ST-segment elevation myocardial infarction (STEMI) has been demonstrated when administered in patients being managed with primary percutaneous coronary intervention (PCI). These trials primarily studied tirofiban utilizing the high-dose bolus regimen (25 microg/kg bolus followed by a maintenance infusion of 0.15 microg/kg/min for 18-24 hours). The On-TIME (Ongoing Tirofiban in Myocardial Infarction Evaluation) 2 trial assessed early administration of the high-dose bolus regimen of tirofiban either at the referral centre or in the ambulance, in patients being transferred to a primary PCI centre. Early use of tirofiban resulted in both a significant increase in the rate of complete resolution of ST-segment deviation pre- and post-PCI, and improvement in clinical outcomes at 30 days. Moreover, the multi-factorial MULTISTRATEGY (Multicentre Evaluation of Single High-Dose Bolus Tirofiban vs Abciximab With Sirolimus-Eluting Stent or Bare Metal Stent in Acute Myocardial Infarction) trial, which compared the high-dose bolus regimen of tirofiban with standard dose administration of abciximab administered immediately prior to PCI, revealed similar effects on myocardial perfusion, ST-segment elevation recovery and clinical outcomes between the two agents, and confirmed the safety of tirofiban when used in combination with drug-eluting stents in patients with STEMI undergoing primary PCI. These studies showed tirofiban to be a well tolerated and effective GP IIb/IIIa inhibitor. On the basis of the demonstrated benefits of the high-dose bolus regimen, tirofiban may be considered useful in the management of patients with STEMI. |
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Authors:
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Arnoud W J van 't Hof; Marco Valgimigli |
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Publication Detail:
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Type: Comparative Study; Journal Article; Review |
Journal Detail:
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Title: Drugs Volume: 69 ISSN: 0012-6667 ISO Abbreviation: Drugs Publication Date: 2009 |
Date Detail:
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Created Date: 2009-02-05 Completed Date: 2009-04-30 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7600076 Medline TA: Drugs Country: New Zealand |
Other Details:
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Languages: eng Pagination: 85-100 Citation Subset: IM |
Affiliation:
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Department of Cardiology, Isala Klinieken, Zwolle, the Netherlands. v.r.c.derks@isala.nl |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Angioplasty, Transluminal, Percutaneous Coronary
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methods Antibodies, Monoclonal / pharmacology, therapeutic use Clinical Trials as Topic Dose-Response Relationship, Drug Humans Immunoglobulin Fab Fragments / pharmacology, therapeutic use Myocardial Infarction / drug therapy* Platelet Aggregation Inhibitors / administration & dosage*, adverse effects Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors Time Factors Tyrosine / administration & dosage, adverse effects, analogs & derivatives* |
| Chemical | |
Reg. No./Substance:
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0/Antibodies, Monoclonal; 0/Immunoglobulin Fab Fragments; 0/Platelet Aggregation Inhibitors; 0/Platelet Glycoprotein GPIIb-IIIa Complex; 143653-53-6/abciximab; 144494-65-5/tirofiban; 55520-40-6/Tyrosine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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