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

Walters, D. L., Ray, M. J., Wood, P., Perrin, E. J., Bett, J. H. N. and Aroney, C. N. (2010) High-dose tirofiban with enoxaparin and inflammatory markers in high-risk percutaneous intervention. European Journal of Clinical Investigation, 40 2: 139-147. doi:10.1111/j.1365-2362.2009.02237.x

Author Walters, D. L.
Ray, M. J.
Wood, P.
Perrin, E. J.
Bett, J. H. N.
Aroney, C. N.
Title High-dose tirofiban with enoxaparin and inflammatory markers in high-risk percutaneous intervention
Journal name European Journal of Clinical Investigation   Check publisher's open access policy
ISSN 0014-2972
Publication date 2010-02-01
Year available 2009
Sub-type Article (original research)
DOI 10.1111/j.1365-2362.2009.02237.x
Volume 40
Issue 2
Start page 139
End page 147
Total pages 9
Place of publication Oxford, United Kingdom
Publisher Wiley-Blackwell Publishing
Language eng
Formatted abstract
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 μg kg -1 bolus). This study measured a panel of platelet activation markers, inflammatory biomarkers and thrombus generation between the two groups.

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.

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.

Keyword Acute coronary syndrome
Percutaneous transluminal angioplasty
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status Non-UQ
Additional Notes Article first published online: 21 DEC 2009 Published under 'Randomized clinical trial'

Document type: Journal Article
Sub-type: Article (original research)
Collections: Non HERDC
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Created: Thu, 17 Mar 2011, 20:54:22 EST by Debbie Banks on behalf of School of Medicine