血小板抑制剂仅适用于部分不稳定性心绞痛患者
ANAHEIM, Mar 16 - One reason that the much-heralded glycoprotein IIb/IIIa platelet inhibitors have shown limited benefit in patients with acute coronary syndromes is that they may be indicated only for the subgroup who are troponin-positive.
Results of PARAGON B, a study of lamifiban (Hoffmann-LaRoche, Inc.), presented here at the annual meeting of the American College of Cardiology by Dr. Robert Harrington, from Duke University Medical Center, Durham, North Carolina, show that the "super aspirin" reduced risk of death and myocardial infarction by 50% in patients who tested positive for troponin T on admission.
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However, for the 5,225 patients in PARAGON B as a whole, 30-day mortality and adverse events was 11.8% in those on lamifiban and 12.8% in those on placebo--not a significant difference. "We were looking for a robust treatment effect, but we didn‘t see it," he said.
Among troponin-positive patients, the adverse event rate at 30 days was 11% in those on lamifiban compared with 19.4% for those on placebo. "We saw a preferential treatment benefit in patients who are troponin-positive," Dr. Harrington announced.
, 百拇医药
Meanwhile, the glycoprotein IIb/IIIa inhibitor eptifibatide (Integrilin, COR Therapeutics, Inc.) reduced mortality and risk of a second MI by 40% in patients in the Enhanced Suppression of the Platelet Receptor glycoprotein IIb/IIIa using Integrilin Therapy (ESPRIT) trial. The trial was halted early because of the positive results.
ESPRIT involved 1,758 patients undergoing elective intracoronary stent placement who were randomized to receive eptifibatide and heparin or placebo and heparin intravenously for up to 24 hours after stent placement.
, 百拇医药
Findings were presented by Dr. James E. Tscheng of Duke. Incidence of death and MI at 48 hours was 5.5% in the eptifibatide group and 9.2% in the placebo group for a risk reduction of 40%. Incidence of a composite of complications at 48 hours was 6.6% in the eptifibatide and 10.5% in the placebo groups, for a risk reduction of 37%, Dr. Tscheng reported. The incidence of bleeding and other adverse effects was low, he added.
One of the major implications of the study is economic, Dr. Tscheng noted. The cost of a single treatment with abciximab--the standard of care with stent placement--is around $1,500. The cost of treatment with eptifibatide is around $400.
, 百拇医药
And--results of the second SYMPHONY trial show that an oral glycoprotein IIb/IIIa inhibitor is less effective than aspirin in preventing mortality and second MI after acute coronary syndromes. Dr. Robert Califf of Duke presented the results of 6,671 patients randomized to low- or high-dose sibrafiban or aspirin. The trial was stopped early because of no advantage of low-dose sibrafiban over aspirin and a higher mortality rate in the high-dose arm.
Four large trials of oral glycoprotein IIb/IIIa receptor inhibitors have all failed to show a benefit over aspirin, Dr. Califf noted.
, http://www.100md.com
Dr. Eugene Braunwald of Partners HealthCare Systems in Boston commented after Dr. Califf‘s presentation, saying "This field is not closed. It‘s a disappointing first chapter, but it‘s far from over...I find it difficult to believe that aspirin will remain [the standard of care] over the next 10 years--especially since intravenous IIb/IIIa agents are so effective.", http://www.100md.com
Results of PARAGON B, a study of lamifiban (Hoffmann-LaRoche, Inc.), presented here at the annual meeting of the American College of Cardiology by Dr. Robert Harrington, from Duke University Medical Center, Durham, North Carolina, show that the "super aspirin" reduced risk of death and myocardial infarction by 50% in patients who tested positive for troponin T on admission.
, http://www.100md.com
However, for the 5,225 patients in PARAGON B as a whole, 30-day mortality and adverse events was 11.8% in those on lamifiban and 12.8% in those on placebo--not a significant difference. "We were looking for a robust treatment effect, but we didn‘t see it," he said.
Among troponin-positive patients, the adverse event rate at 30 days was 11% in those on lamifiban compared with 19.4% for those on placebo. "We saw a preferential treatment benefit in patients who are troponin-positive," Dr. Harrington announced.
, 百拇医药
Meanwhile, the glycoprotein IIb/IIIa inhibitor eptifibatide (Integrilin, COR Therapeutics, Inc.) reduced mortality and risk of a second MI by 40% in patients in the Enhanced Suppression of the Platelet Receptor glycoprotein IIb/IIIa using Integrilin Therapy (ESPRIT) trial. The trial was halted early because of the positive results.
ESPRIT involved 1,758 patients undergoing elective intracoronary stent placement who were randomized to receive eptifibatide and heparin or placebo and heparin intravenously for up to 24 hours after stent placement.
, 百拇医药
Findings were presented by Dr. James E. Tscheng of Duke. Incidence of death and MI at 48 hours was 5.5% in the eptifibatide group and 9.2% in the placebo group for a risk reduction of 40%. Incidence of a composite of complications at 48 hours was 6.6% in the eptifibatide and 10.5% in the placebo groups, for a risk reduction of 37%, Dr. Tscheng reported. The incidence of bleeding and other adverse effects was low, he added.
One of the major implications of the study is economic, Dr. Tscheng noted. The cost of a single treatment with abciximab--the standard of care with stent placement--is around $1,500. The cost of treatment with eptifibatide is around $400.
, 百拇医药
And--results of the second SYMPHONY trial show that an oral glycoprotein IIb/IIIa inhibitor is less effective than aspirin in preventing mortality and second MI after acute coronary syndromes. Dr. Robert Califf of Duke presented the results of 6,671 patients randomized to low- or high-dose sibrafiban or aspirin. The trial was stopped early because of no advantage of low-dose sibrafiban over aspirin and a higher mortality rate in the high-dose arm.
Four large trials of oral glycoprotein IIb/IIIa receptor inhibitors have all failed to show a benefit over aspirin, Dr. Califf noted.
, http://www.100md.com
Dr. Eugene Braunwald of Partners HealthCare Systems in Boston commented after Dr. Califf‘s presentation, saying "This field is not closed. It‘s a disappointing first chapter, but it‘s far from over...I find it difficult to believe that aspirin will remain [the standard of care] over the next 10 years--especially since intravenous IIb/IIIa agents are so effective.", http://www.100md.com