Effects of different thrombolytic treatment regimen with abciximab and tirofiban on XXXX and platelet-leukocyte interactions: a subgroup analysis from the GUSTO V and FASTER trials.

@entity1 @entity1423 @entity6541 @entity11603 @entity8729 @entity1427 @entity9536 @entity4732
BACKGROUND: Due to considerably high rates of reocclusion under standard thrombolytic therapy @entity1427 /IIIa inhibitors have been combined with thrombolytics to improve therapeutic outcomes. Potential reasons for arterial reocclusion may be increased platelet activation, interaction of platelets with other cell types such as leukocytes and inadequate drug dosing due to lack of ideal platelet monitoring. We compared combination therapy regimens consisting of @entity1427 /IIIa inhibitors and thrombolytics with respect to platelet inhibition and platelet-leukocyte interactions. METHODS AND RESULTS: From the GUSTO V trial (standard rPA vs. reduced dose rPA and abciximab) and the FASTER trial (standard TNK-tPA vs. reduced dose TNK-tPA and tirofiban) 15 @entity1 were monitored by platelet aggregometry, rapid platelet function assay (RPFA) and flow cytometry (FC). rPA alone (n = 5) caused initial @entity1423 . However, @entity1423 was significantly (p < 0.05) and sufficiently (>80%) inhibited by abciximab/rPA (n = 5) and tirofiban/TNK-tPA (n = 5). The platelet inhibitory effect of @entity6541 /TNK-tPA was more pronounced compared to abciximab/rPA with a significant difference after 2 h (p < 0.05). Tirofiban/TNK-tPA and abciximab/rPA caused decreases in platelet-leukocyte aggregates as well as in binding of specific antibodies to the platelet @entity4732 receptor and @entity8729 (p < 0.05, respect.). No differences among the treatment groups were seen with respect to antibody binding to @entity9536 and @entity11603 / @entity11603 . CONCLUSIONS: Taken together, @entity1427 /IIIa inhibitors overcome the platelet activating effect of thrombolytics resulting in sufficient platelet inhibition. RPFA is a suitable monitoring tool to accurately assess platelet inhibition. Within the given combination treatment regimen tirofiban appears to be more effective compared to abciximab and to exert effects beyond the inhibition of @entity1427 /IIIa.
