Key result
Tirofiban maintained a significantly higher extent of platelet inhibition after 15 minutes compared to eptifibatide in blood from patients with (95% vs 70%, P<0.001) and without diabetes.
Why the study?
Does tirofiban maintain inhibitory effects on fibrinogen binding to platelets better than eptifibatide in blood from patients with and without diabetes mellitus?
Does tirofiban maintain inhibitory effects on fibrinogen binding to platelets better than eptifibatide in blood from patients with and without diabetes mellitus?
Tirofiban maintains its inhibitory effect on platelet fibrinogen binding more effectively over time than eptifibatide in blood from both diabetic and non-diabetic patients.
This is the authors' abstract. We don't add key points for this paper.
OBJECTIVES: Both tirofiban and eptifibatide release rapidly from glycoprotein IIb-IIIa but have different dissociation constants (KD of tirofiban=15 nmol/l, of eptifibatide=120 nmol/l). Binding of fibrinogen to glycoprotein IIb-IIIa is biphasic, forming an initial reversible complex (KD=155-180 nmol/l) and a second more stable complex (KD=20-70 nmol/l). Diabetes is known to alter platelet function. To determine the influence of affinity on inhibitory effects in blood from patients with (n=20) and without (n=20) diabetes mellitus, we characterized the extent of inhibition as a function of time. METHODS: Blood was added to reaction tubes containing tirofiban 100 ng/ml or eptifibatide 1.7 microg/ml (concentrations previously defined to be optimal) plus a platelet agonist (1 micromol/l adenosine diphosphate or 25 micromol/l thrombin receptor agonist peptide), and fluorochrome-labeled fibrinogen before analysis by flow cytometry. RESULTS: The extent of inhibition early on (30 s to 3 min) was similar (>85%) with either agent in blood from those with and without diabetes mellitus, whereas the extent of inhibition 10-15 min later was maintained more effectively with tirofiban than with eptifibatide (difference in slope P<0.01). After 15 min, the extent of inhibition in response to adenosine diphosphate in those with diabetes mellitus was 95+/-6% for tirofiban and 70+/-15% for eptifibatide (P<0.001); in those without diabetes mellitus, it was 91+/-9% for tirofiban and 73+/-19% for eptifibatide (P<0.001). CONCLUSION: For glycoprotein IIb-IIIa antagonists with a rapid rate of release, the biphasic binding of fibrinogen influences to a similar extent their ability to maintain inhibitory effects in blood from patients with and without diabetes mellitus.
Answers are grounded in this paper and cite their sources.
May support preferring tirofiban for rapid platelet inhibition in diabetes; leaves open clinical translation from ex vivo data.
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Schneider et al. (2005) studied Diabetes mellitus (n=40). Tirofiban vs. Eptifibatide 1.7 microg/ml was evaluated on Extent of platelet inhibition in response to adenosine diphosphate after 15 min in patients with diabetes mellitus (p=<0.001). Tirofiban maintained a significantly higher extent of platelet inhibition after 15 minutes compared to eptifibatide in blood from patients with (95% vs 70%, P<0.001) and without diabetes.
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