OBJECTIVES: The authors sought to compare the effect on inhibition of platelet aggregation (IPA) of prasugrel therapy versus tirofiban bolus with or without a post-bolus short drug infusion in ST-segment elevation myocardial infarction (STEMI) patients. BACKGROUND: The degree and rapidity of IPA after prasugrel alone with or without concomitant glycoprotein IIb/IIIa inhibition in STEMI patients is unknown. METHODS: A total of 100 STEMI patients randomly received prasugrel 60 mg versus 25 μg/kg tirofiban bolus with or without post-bolus 2-h infusion of tirofiban, with or without concomitant prasugrel. IPA at light transmission aggregometry was performed throughout 24 h. The primary endpoint was IPA stimulated with 20 μmol/l adenosine diphosphate (ADP) at 30 min. RESULTS: At 30 min, patients in the prasugrel group showed a significantly lower IPA to 20 μmol/l ADP stimulation as compared with tirofiban-treated patients (36 ± 35 vs. 87 ± 31, p < 0.0001). Similarly, patients taking prasugrel showed a suboptimal degree of platelet inhibition for at least 2 h compared with tirofiban patients. Post-bolus tirofiban infusion was necessary to maintain a high level of IPA beyond 1 h after bolus administration if concomitant clopidogrel was given, whereas the bolus-only tirofiban and concomitant prasugrel led to the higher and more consistent IPA levels after both ADP and thrombin receptor-activating peptide stimuli than either therapy alone. CONCLUSIONS: Our study shows that prasugrel administration leads to a suboptimal IPA for at least 2 h in STEMI patients. Yet, prasugrel, given in association with a bolus only of glycoprotein IIb/IIIa inhibitor, obviates the need of post-bolus infusion and almost completely abolishes residual variability of IPA after treatment. (Facilitation through Aggrastat By drOpping or shortening Infusion Line in patients with ST-segment elevation myocardial infarction compared to or on top of PRasugrel given at loading dOse [The FABOLUS PRO trial]; NCT01336348).
RCT Entities:
OBJECTIVES: The authors sought to compare the effect on inhibition of platelet aggregation (IPA) of prasugrel therapy versus tirofiban bolus with or without a post-bolus short drug infusion in ST-segment elevation myocardial infarction (STEMI) patients. BACKGROUND: The degree and rapidity of IPA after prasugrel alone with or without concomitant glycoprotein IIb/IIIa inhibition in STEMI patients is unknown. METHODS: A total of 100 STEMI patients randomly received prasugrel 60 mg versus 25 μg/kg tirofiban bolus with or without post-bolus 2-h infusion of tirofiban, with or without concomitant prasugrel. IPA at light transmission aggregometry was performed throughout 24 h. The primary endpoint was IPA stimulated with 20 μmol/l adenosine diphosphate (ADP) at 30 min. RESULTS: At 30 min, patients in the prasugrel group showed a significantly lower IPA to 20 μmol/l ADP stimulation as compared with tirofiban-treated patients (36 ± 35 vs. 87 ± 31, p < 0.0001). Similarly, patients taking prasugrel showed a suboptimal degree of platelet inhibition for at least 2 h compared with tirofibanpatients. Post-bolus tirofiban infusion was necessary to maintain a high level of IPA beyond 1 h after bolus administration if concomitant clopidogrel was given, whereas the bolus-only tirofiban and concomitant prasugrel led to the higher and more consistent IPA levels after both ADP and thrombin receptor-activating peptide stimuli than either therapy alone. CONCLUSIONS: Our study shows that prasugrel administration leads to a suboptimal IPA for at least 2 h in STEMI patients. Yet, prasugrel, given in association with a bolus only of glycoprotein IIb/IIIa inhibitor, obviates the need of post-bolus infusion and almost completely abolishes residual variability of IPA after treatment. (Facilitation through Aggrastat By drOpping or shortening Infusion Line in patients with ST-segment elevation myocardial infarction compared to or on top of PRasugrel given at loading dOse [The FABOLUS PRO trial]; NCT01336348).
Authors: Hector Tamez; Duane S Pinto; Ajay J Kirtane; Claire Litherland; Robert W Yeh; George D Dangas; Roxana Mehran; Efthymios N Deliargyris; Guillermo Ortiz; C Michael Gibson; Gregg W Stone Journal: JAMA Cardiol Date: 2017-06-01 Impact factor: 14.676
Authors: Marco Valgimigli; Paolo Calabrò; Bernardo Cortese; Enrico Frigoli; Stefano Garducci; Paolo Rubartelli; Giuseppe Andò; Andrea Santarelli; Mario Galli; Roberto Garbo; Alessandra Repetto; Salvatore Ierna; Carlo Briguori; Ugo Limbruno; Roberto Violini; Andrea Gagnor Journal: J Cardiovasc Transl Res Date: 2014-01-07 Impact factor: 4.132
Authors: Giuseppe Gargiulo; Giovanni Esposito; Plinio Cirillo; Michael Nagler; Pietro Minuz; Gianluca Campo; Felice Gragnano; Negar Manavifar; Raffaele Piccolo; Marisa Avvedimento; Matteo Tebaldi; Andreas Wahl; Lukas Hunziker; Michael Billinger; Dik Heg; Stephan Windecker; Marco Valgimigli Journal: J Cardiovasc Transl Res Date: 2020-02-24 Impact factor: 4.132
Authors: Michelle A Berny-Lang; Joseph A Jakubowski; Atsuhiro Sugidachi; Marc R Barnard; Alan D Michelson; Andrew L Frelinger Journal: J Am Heart Assoc Date: 2013-05-15 Impact factor: 5.501