Additive effects between platelet concentrates and desmopressin in antagonizing the platelet glycoprotein IIb/IIIa inhibitor eptifibatide.
BACKGROUND
Platelet (PLT) glycoprotein (GP) IIb/IIIa receptor antagonists have demonstrated efficacy in decreasing ischemic complications of percutaneous coronary intervention and/or unstable angina. In case of bleeding, the drug can be stopped and PLT transfusions can be given.


METHODS
This crossover study tested the additive effects of PLT concentrates (PCs) after desmopressin (DDAVP) infusion in antagonizing the anti-PLT effects of GPIIb/IIIa inhibitors and aspirin. After eptifibatide and aspirin infusion (at standard dosages), 10 healthy volunteers received DDAVP or placebo. Thereafter, increasing amounts of PLTs from fresh single-donor apheresis concentrates were added in vitro to blood samples of all volunteers to increase PLT counts by 30 x 10(9), 60 x 10(9), or 120 x 10(9) per L.


RESULTS
Adding platelets in vitro further improved PLT function after DDAVP: it shortened collagen-adenosine diphosphate closure times (p < 0.01), to normal ranges as measured by the PLT function analyzer (PFA-100). In contrast, normal PLT function could not be restored even when PLT counts were increased by 50 percent (120 x 10(9)/L) in the placebo group.


CONCLUSIONS
Combined use of PLTs from fresh apheresis PC and DDAVP additively enhances recovery of normal PLT function after eptifibatide infusion. Such a strategy may help to avoid excessive transfusion of PC.
Reiter
Rosemarie
R
Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria.
Jilma-Stohlawetz
Petra
P
Horvath
Michaela
M
Jilma
Bernd
B
D000328:Adult; D000925:Anticoagulants; D001241:Aspirin / Q000008:administration & dosage; D001781:Blood Component Removal; D001792:Blood Platelets / Q000187:drug effects; D018592:Cross-Over Studies; D003894:Deamino Arginine Vasopressin / Q000008:administration & dosage*; D004357:Drug Synergism; D000077542:Eptifibatide; D006490:Hemostatics / Q000008:administration & dosage*; D006629:Hirudins / Q000031:analogs & derivatives*; D006801:Humans; D008297:Male; D010455:Peptides / Q000008:administration & dosage*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D017713:Platelet Transfusion; D011994:Recombinant Proteins
D000925:Anticoagulants; D006490:Hemostatics; D006629:Hirudins; D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D011994:Recombinant Proteins; D003894:Deamino Arginine Vasopressin; D000077542:Eptifibatide; D001241:Aspirin; C083544:lepirudin