TY - JOUR
T1 - High levels of platelet inhibition with abciximab despite heightened platelet activation and aggregation during thrombolysis for acute myocardial infarction
T2 - Results from TIMI (thrombolysis in myocardial infarction) 14
AU - Coulter, Stephanie A.
AU - Cannon, Christopher P.
AU - Ault, Kenneth A.
AU - Antman, Elliott M.
AU - Van De Werf, Frans
AU - Adgey, A. A Jennifer
AU - Gibson, C. Michael
AU - Giugliano, Robert P.
AU - Mascelli, Mary A.
AU - Scherer, Joel
AU - Barnathan, Elliot S.
AU - Braunwald, Eugene
AU - Kleiman, Neal S.
PY - 2000/6/13
Y1 - 2000/6/13
N2 - Background - We evaluated platelet activation and aggregation in patients with acute myocardial infarction (AMI) treated with thrombolytic therapy alone or with reduced-dose thrombolysis and concomitant abciximab. Methods and Results - The study was performed in 20 control subjects and 51 patients with AMI before and after reperfusion with either alteplase or reteplase or reduced doses of these agents with concomitant abciximab. Platelet activation was assayed by platelet surface expression of P-selectin. Turbidometric platelet aggregation in response to ADP was measured in patients before thrombolytic therapy and 90 minutes and 24 hours after the beginning of thrombolytic therapy. P-selectin expression was greater at baseline in patients than normal control subjects (30.4% versus 9.8%, P < 0.0001) but was identical between the 2 groups after stimulation with ADP (64.4% versus 69.3%, P = 0.37). However, at 24 hours, basal P-selectin expression declined in patients (P = 0.0025 versus baseline), whereas ADP- stimulated P-selectin expression was lower in patients than in control subjects (48% versus 69%, P = 0.0004). When combined with reduced doses of either alteplase or reteplase, abciximab achieved 91% and 83% inhibition of 5 and 20 μmol/L ADP-induced platelet aggregation, which decreased to 46% and 40%, respectively, at 24 hours. No appreciable difference in the platelet inhibition profile of abciximab was observed between the 2 thrombolytics. Conclusions - Platelet activation and aggregation are heightened in the setting of thrombolysis for AMI. Despite this enhanced level of platelet activation, abciximab, combined with a reduced-dose thrombolytic, inhibited platelet aggregation similarly to the level reported in elective settings.
AB - Background - We evaluated platelet activation and aggregation in patients with acute myocardial infarction (AMI) treated with thrombolytic therapy alone or with reduced-dose thrombolysis and concomitant abciximab. Methods and Results - The study was performed in 20 control subjects and 51 patients with AMI before and after reperfusion with either alteplase or reteplase or reduced doses of these agents with concomitant abciximab. Platelet activation was assayed by platelet surface expression of P-selectin. Turbidometric platelet aggregation in response to ADP was measured in patients before thrombolytic therapy and 90 minutes and 24 hours after the beginning of thrombolytic therapy. P-selectin expression was greater at baseline in patients than normal control subjects (30.4% versus 9.8%, P < 0.0001) but was identical between the 2 groups after stimulation with ADP (64.4% versus 69.3%, P = 0.37). However, at 24 hours, basal P-selectin expression declined in patients (P = 0.0025 versus baseline), whereas ADP- stimulated P-selectin expression was lower in patients than in control subjects (48% versus 69%, P = 0.0004). When combined with reduced doses of either alteplase or reteplase, abciximab achieved 91% and 83% inhibition of 5 and 20 μmol/L ADP-induced platelet aggregation, which decreased to 46% and 40%, respectively, at 24 hours. No appreciable difference in the platelet inhibition profile of abciximab was observed between the 2 thrombolytics. Conclusions - Platelet activation and aggregation are heightened in the setting of thrombolysis for AMI. Despite this enhanced level of platelet activation, abciximab, combined with a reduced-dose thrombolytic, inhibited platelet aggregation similarly to the level reported in elective settings.
KW - Abciximab
KW - Myocardial infarction
KW - Platelets
KW - Thrombolysis
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U2 - 10.1161/01.CIR.101.23.2690
DO - 10.1161/01.CIR.101.23.2690
M3 - Article
C2 - 10851205
AN - SCOPUS:0034643938
SN - 0009-7322
VL - 101
SP - 2690
EP - 2695
JO - Circulation
JF - Circulation
IS - 23
ER -