title: Long-term clinical outcomes of platelet glycoprotein IIb/IIIa inhibitor combined with low molecular weight heparin in patients with acute coronary syndrome.
abstract: BACKGROUND
  Platelet activation and aggregation with resultant arterial thrombus formation play a pivotal role in the pathophysiology of acute coronary syndrome (ACS). In the present study the efficacy of tirofiban, a specific inhibitor of the platelet glycoprotein IIb/IIIa receptor, combined with heparin or low-molecular-weight heparin (dalteparin), was evaluated for the management of ACS.
  
  
  RESULTS
  One hundred and sixty patients (60.9+/-11.1 years, 104 male) with unstable angina or non-ST elevation myocardial infarction and who had ST-T changes and elevated troponin were randomly assigned to 4 groups: group I (n=40: heparin alone), group II (n=40: dalteparin alone), group III (n=40: tirofiban + heparin) and group IV (n=40: tirofiban + dalteparin). The occurrence of major adverse cardiac events (MACE) was compared prospectively during a 6-month clinical follow-up. Percutaneous coronary intervention or coronary artery bypass graft was performed in 32 cases in group I, 29 in group II, 28 in group III and 31 in group IV (p=0.72). Minor bleeding complication developed in 2 patients (5.0%) in group I, 2 (5.0%) in group II, 4 (10.0%) in group III and 3 (7.5%) in group IV (p=0.78). During the follow-up MACE occurred in 10 patients (31.3%) in group I, 9 (31.0%) in group II, 4 (14.3%) in group III and 4 (12.9%) in group IV (p=0.02: Group I and II vs Group III and IV).
  
  
  CONCLUSIONS
  Tirofiban combined with dalteparin was associated with relatively more bleeding complications in the short term, but was effective in reducing the incidence of MACE during long-term clinical follow-up in patients with ACS.
authors.affiliation: The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea.
authors.forename: Ju Han
authors.initials: JH
authors.lastname: Kim
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Jay Young
authors.initials: JY
authors.lastname: Rhew
authors.forename: Ji Hyun
authors.initials: JH
authors.lastname: Lim
authors.forename: Kyung Ho
authors.initials: KH
authors.lastname: Yun
authors.forename: Kye Hun
authors.initials: KH
authors.lastname: Kim
authors.forename: Dong Koo
authors.initials: DK
authors.lastname: Kang
authors.forename: Seo Na
authors.initials: SN
authors.lastname: Hong
authors.forename: Sang Yup
authors.initials: SY
authors.lastname: Lim
authors.forename: Sang Hyun
authors.initials: SH
authors.lastname: Lee
authors.forename: Yeon Sang
authors.initials: YS
authors.lastname: Lee
authors.forename: Young Joon
authors.initials: YJ
authors.lastname: Hong
authors.forename: Hyung Wook
authors.initials: HW
authors.lastname: Park
authors.forename: Weon
authors.initials: W
authors.lastname: Kim
authors.forename: Young Keun
authors.initials: YK
authors.lastname: Ahn
authors.forename: Yong
authors.initials: Y
authors.lastname: Moon
authors.forename: Jeong Gwang
authors.initials: JG
authors.lastname: Cho
authors.forename: Jong Chun
authors.initials: JC
authors.lastname: Park
authors.forename: Jung Chaee
authors.initials: JC
authors.lastname: Kang
mesh_terms: D000208:Acute Disease; D000368:Aged; D003327:Coronary Disease / Q000188:drug therapy* / Q000517:prevention & control; D017985:Dalteparin / Q000009:adverse effects / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006493:Heparin / Q000009:adverse effects / Q000627:therapeutic use; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000009:adverse effects / Q000031:analogs & derivatives / Q000627:therapeutic use
chemical_list: D006495:Heparin, Low-Molecular-Weight; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; D006493:Heparin; D000077466:Tirofiban; D017985:Dalteparin