Key result
Tirofiban combined with heparin or LMWH significantly reduced 6-month major adverse cardiac events compared to heparin or LMWH alone (15.8% and 18.2% vs 30.4% and 31.6%; p=0.02).
Why the study?
Does tirofiban combined with heparin or low molecular weight heparin reduce major adverse cardiac events in patients with unstable angina or NSTEMI?
Does tirofiban combined with heparin or low molecular weight heparin reduce major adverse cardiac events in patients with unstable angina or NSTEMI?
Absolute Event Rate: 18.2% vs 31.6%
p-value: p=0.02
The addition of tirofiban to heparin or low molecular weight heparin in patients with acute coronary syndrome appears safe and significantly reduces major adverse cardiac events at 6 months.
Tirofiban appears safe without excess bleeding in ACS; leaves open efficacy of heparin combinations for randomized trials.
Background and Objectives:Platelet activation and aggregation, with resultant arterial thrombus formation, play pivotal roles in the pathophysiology of acute coronary syndrome (ACS). The efficacy of tirofiban, a specific inhibitor of the platelet glycoprotein IIb/IIIa receptor, combined with heparin, or low molecular heparin (LMWH), in the management of ACS were evaluated. Subjects and Methods:One hundred seventeen patients (60.8± 10.9 years, 76 male), with unstable angina or non-ST elevation myocardial infarction, who had ST-T changes and elevated troponin, were divided into 4 groups:Group I (n=30:heparin alone), Group II (n=28:LMWH, dalteparin alone), Group III (n=29:tirofiban combined with heparin) and Group IV (n=30:tirofiban with LMWH). The major adverse cardiac events (MACE) among the 4 groups, during 6-month clinical follow-ups, were compared. Results:Percutaneous coronary intervention, or a coronary artery bypass graft, was performed in 23, 19, 19 and 22 patients from Groups I, II, III and IV, respectively (p=0.87). A minor bleeding complication developed in 2 (6.7%), 1 (3.6%), 1 (3.4%) and 2 patients (6.7%) in groups I, II, III and IV, respectively (p=0.79). During the six-month follow-up MACE occurred in 7 (30.4%), 6 (31.6%), 3 (15.8%) and 4 patients (18.2%) in groups I, II, III and IV, respectively (p=0.02:Group I and II vs. Group III and IV). Conclusion: Tirofiban combined with LMWH is safe and may improve the long-term prognosis of patients with ACS. (Korean Circulation J 2003;33 (7):559-567)
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Kim et al. (2003) studied Acute coronary syndrome (unstable angina or non-ST elevation myocardial infarction) (n=117). Tirofiban combined with low molecular weight heparin (LMWH) or heparin vs. LMWH or heparin alone was evaluated on Major adverse cardiac events (MACE) (p=0.02). Tirofiban combined with heparin or LMWH significantly reduced 6-month major adverse cardiac events compared to heparin or LMWH alone (15.8% and 18.2% vs 30.4% and 31.6%; p=0.02).
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