Prasugrel versus tirofiban bolus with or without short post-bolus infusion with or without concomitant prasugrel administration in patients with myocardial infarction undergoing coronary stenting: the FABOLUS PRO (Facilitation through Aggrastat By drOpping or shortening Infusion Line in patients with ST-segment elevation myocardial infarction compared to or on top of PRasugrel given at loading dOse) trial
The authors sought to compare the effect on inhibition of platelet aggregation (IPA) of prasugrel therapy versus tirofiban bolus with or without a post-bolus short drug infusion in ST-segment elevation myocardial infarction (STEMI) patients. The degree and rapidity of IPA after prasugrel alone with...
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| Veröffentlicht in: | JACC. Cardiovascular interventions 2012-03, Vol.5 (3), p.268-277 |
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| creator | Valgimigli, Marco Tebaldi, Matteo Campo, Gianluca Gambetti, Stefania Bristot, Laura Monti, Monia Parrinello, Giovanni Ferrari, Roberto |
| description | The authors sought to compare the effect on inhibition of platelet aggregation (IPA) of prasugrel therapy versus tirofiban bolus with or without a post-bolus short drug infusion in ST-segment elevation myocardial infarction (STEMI) patients.
The degree and rapidity of IPA after prasugrel alone with or without concomitant glycoprotein IIb/IIIa inhibition in STEMI patients is unknown.
A total of 100 STEMI patients randomly received prasugrel 60 mg versus 25 μg/kg tirofiban bolus with or without post-bolus 2-h infusion of tirofiban, with or without concomitant prasugrel. IPA at light transmission aggregometry was performed throughout 24 h. The primary endpoint was IPA stimulated with 20 μmol/l adenosine diphosphate (ADP) at 30 min.
At 30 min, patients in the prasugrel group showed a significantly lower IPA to 20 μmol/l ADP stimulation as compared with tirofiban-treated patients (36 ± 35 vs. 87 ± 31, p < 0.0001). Similarly, patients taking prasugrel showed a suboptimal degree of platelet inhibition for at least 2 h compared with tirofiban patients. Post-bolus tirofiban infusion was necessary to maintain a high level of IPA beyond 1 h after bolus administration if concomitant clopidogrel was given, whereas the bolus-only tirofiban and concomitant prasugrel led to the higher and more consistent IPA levels after both ADP and thrombin receptor-activating peptide stimuli than either therapy alone.
Our study shows that prasugrel administration leads to a suboptimal IPA for at least 2 h in STEMI patients. Yet, prasugrel, given in association with a bolus only of glycoprotein IIb/IIIa inhibitor, obviates the need of post-bolus infusion and almost completely abolishes residual variability of IPA after treatment. (Facilitation through Aggrastat By drOpping or shortening Infusion Line in patients with ST-segment elevation myocardial infarction compared to or on top of PRasugrel given at loading dOse [The FABOLUS PRO trial]; NCT01336348). |
| doi_str_mv | 10.1016/j.jcin.2012.01.006 |
| format | Article |
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The degree and rapidity of IPA after prasugrel alone with or without concomitant glycoprotein IIb/IIIa inhibition in STEMI patients is unknown.
A total of 100 STEMI patients randomly received prasugrel 60 mg versus 25 μg/kg tirofiban bolus with or without post-bolus 2-h infusion of tirofiban, with or without concomitant prasugrel. IPA at light transmission aggregometry was performed throughout 24 h. The primary endpoint was IPA stimulated with 20 μmol/l adenosine diphosphate (ADP) at 30 min.
At 30 min, patients in the prasugrel group showed a significantly lower IPA to 20 μmol/l ADP stimulation as compared with tirofiban-treated patients (36 ± 35 vs. 87 ± 31, p < 0.0001). Similarly, patients taking prasugrel showed a suboptimal degree of platelet inhibition for at least 2 h compared with tirofiban patients. Post-bolus tirofiban infusion was necessary to maintain a high level of IPA beyond 1 h after bolus administration if concomitant clopidogrel was given, whereas the bolus-only tirofiban and concomitant prasugrel led to the higher and more consistent IPA levels after both ADP and thrombin receptor-activating peptide stimuli than either therapy alone.
Our study shows that prasugrel administration leads to a suboptimal IPA for at least 2 h in STEMI patients. Yet, prasugrel, given in association with a bolus only of glycoprotein IIb/IIIa inhibitor, obviates the need of post-bolus infusion and almost completely abolishes residual variability of IPA after treatment. (Facilitation through Aggrastat By drOpping or shortening Infusion Line in patients with ST-segment elevation myocardial infarction compared to or on top of PRasugrel given at loading dOse [The FABOLUS PRO trial]; NCT01336348).</description><identifier>EISSN: 1876-7605</identifier><identifier>DOI: 10.1016/j.jcin.2012.01.006</identifier><identifier>PMID: 22440491</identifier><language>eng</language><publisher>United States</publisher><subject><![CDATA[Aged ; Aged, 80 and over ; Angioplasty, Balloon, Coronary - adverse effects ; Angioplasty, Balloon, Coronary - instrumentation ; Drug Administration Schedule ; Drug Therapy, Combination ; Female ; Humans ; Infusions, Intravenous ; Injections, Intravenous ; Italy ; Male ; Middle Aged ; Myocardial Infarction - blood ; Myocardial Infarction - therapy ; Piperazines - administration & dosage ; Platelet Aggregation - drug effects ; Platelet Aggregation Inhibitors - administration & dosage ; Platelet Function Tests ; Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors ; Platelet Glycoprotein GPIIb-IIIa Complex - metabolism ; Prasugrel Hydrochloride ; Predictive Value of Tests ; Prospective Studies ; Purinergic P2Y Receptor Antagonists - administration & dosage ; Stents ; Thiophenes - administration & dosage ; Ticlopidine - administration & dosage ; Ticlopidine - analogs & derivatives ; Time Factors ; Treatment Outcome ; Tyrosine - administration & dosage ; Tyrosine - analogs & derivatives]]></subject><ispartof>JACC. Cardiovascular interventions, 2012-03, Vol.5 (3), p.268-277</ispartof><rights>Copyright © 2012 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/22440491$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Valgimigli, Marco</creatorcontrib><creatorcontrib>Tebaldi, Matteo</creatorcontrib><creatorcontrib>Campo, Gianluca</creatorcontrib><creatorcontrib>Gambetti, Stefania</creatorcontrib><creatorcontrib>Bristot, Laura</creatorcontrib><creatorcontrib>Monti, Monia</creatorcontrib><creatorcontrib>Parrinello, Giovanni</creatorcontrib><creatorcontrib>Ferrari, Roberto</creatorcontrib><creatorcontrib>FABOLUS PRO Investigators</creatorcontrib><title>Prasugrel versus tirofiban bolus with or without short post-bolus infusion with or without concomitant prasugrel administration in patients with myocardial infarction undergoing coronary stenting: the FABOLUS PRO (Facilitation through Aggrastat By drOpping or shortening Infusion Line in patients with ST-segment elevation myocardial infarction compared to or on top of PRasugrel given at loading dOse) trial</title><title>JACC. Cardiovascular interventions</title><addtitle>JACC Cardiovasc Interv</addtitle><description>The authors sought to compare the effect on inhibition of platelet aggregation (IPA) of prasugrel therapy versus tirofiban bolus with or without a post-bolus short drug infusion in ST-segment elevation myocardial infarction (STEMI) patients.
The degree and rapidity of IPA after prasugrel alone with or without concomitant glycoprotein IIb/IIIa inhibition in STEMI patients is unknown.
A total of 100 STEMI patients randomly received prasugrel 60 mg versus 25 μg/kg tirofiban bolus with or without post-bolus 2-h infusion of tirofiban, with or without concomitant prasugrel. IPA at light transmission aggregometry was performed throughout 24 h. The primary endpoint was IPA stimulated with 20 μmol/l adenosine diphosphate (ADP) at 30 min.
At 30 min, patients in the prasugrel group showed a significantly lower IPA to 20 μmol/l ADP stimulation as compared with tirofiban-treated patients (36 ± 35 vs. 87 ± 31, p < 0.0001). Similarly, patients taking prasugrel showed a suboptimal degree of platelet inhibition for at least 2 h compared with tirofiban patients. Post-bolus tirofiban infusion was necessary to maintain a high level of IPA beyond 1 h after bolus administration if concomitant clopidogrel was given, whereas the bolus-only tirofiban and concomitant prasugrel led to the higher and more consistent IPA levels after both ADP and thrombin receptor-activating peptide stimuli than either therapy alone.
Our study shows that prasugrel administration leads to a suboptimal IPA for at least 2 h in STEMI patients. Yet, prasugrel, given in association with a bolus only of glycoprotein IIb/IIIa inhibitor, obviates the need of post-bolus infusion and almost completely abolishes residual variability of IPA after treatment. (Facilitation through Aggrastat By drOpping or shortening Infusion Line in patients with ST-segment elevation myocardial infarction compared to or on top of PRasugrel given at loading dOse [The FABOLUS PRO trial]; NCT01336348).</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Angioplasty, Balloon, Coronary - adverse effects</subject><subject>Angioplasty, Balloon, Coronary - instrumentation</subject><subject>Drug Administration Schedule</subject><subject>Drug Therapy, Combination</subject><subject>Female</subject><subject>Humans</subject><subject>Infusions, Intravenous</subject><subject>Injections, Intravenous</subject><subject>Italy</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - blood</subject><subject>Myocardial Infarction - therapy</subject><subject>Piperazines - administration & dosage</subject><subject>Platelet Aggregation - drug effects</subject><subject>Platelet Aggregation Inhibitors - administration & dosage</subject><subject>Platelet Function Tests</subject><subject>Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors</subject><subject>Platelet Glycoprotein GPIIb-IIIa Complex - metabolism</subject><subject>Prasugrel Hydrochloride</subject><subject>Predictive Value of Tests</subject><subject>Prospective Studies</subject><subject>Purinergic P2Y Receptor Antagonists - administration & dosage</subject><subject>Stents</subject><subject>Thiophenes - administration & dosage</subject><subject>Ticlopidine - administration & dosage</subject><subject>Ticlopidine - analogs & derivatives</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>Tyrosine - administration & dosage</subject><subject>Tyrosine - analogs & derivatives</subject><issn>1876-7605</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2012</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNptUsuO1DAQDEiIfcAPcEB9gz1ksPN0uM2uGFhppKzY3fPIcTqJR4kdbGfQ_AmfizMPLsvFdpeqq6ptB8EHShaU0OzLdrEVUi0iQqMFoQtCstfBJWV5FuYZSS-CK2u3HiRFHr0NLqIoSUhS0MtXfx4Mt1NrsIcdGjtZcNLoRlZcQaV7X_-WrgNtDrueHNhOGwejti48EqRqJiu1esEUWgk9SMeV5_-z4fUglbTOcDc3SQWjP6FyJ6thrwU3teT9rMyNONAmVaNptVStlzVacbMH63yXR76C6xBWy9ty_fwIDz9L-LziQvbe-dDrOqOntoNl2_oUHoTbPdSmHMdZzgc-jIRqru7Pw6ylwpfhHp9Ci-3gAcAed0f9_yf2o4_cYA1Ozx5zDj2CbnzA81W0cocKfJ5e83p2r0uLN-CMl3oXvGl4b_H9ab8Onlffnu5-hOvy-_3dch2ONCEuFDSPY5rVDBtBWJSyhIm0xrzgTRMXtIjjIsqqhAtGI1GwDKsIWcL9muVCxGl8HXw66o5G_5rQus0grcC-5wr1ZDdFwliRpIx55scTc6oGrDejkYN_hs35M8V_AdL82RM</recordid><startdate>201203</startdate><enddate>201203</enddate><creator>Valgimigli, Marco</creator><creator>Tebaldi, Matteo</creator><creator>Campo, Gianluca</creator><creator>Gambetti, Stefania</creator><creator>Bristot, Laura</creator><creator>Monti, Monia</creator><creator>Parrinello, Giovanni</creator><creator>Ferrari, Roberto</creator><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>7X8</scope></search><sort><creationdate>201203</creationdate><title>Prasugrel versus tirofiban bolus with or without short post-bolus infusion with or without concomitant prasugrel administration in patients with myocardial infarction undergoing coronary stenting: the FABOLUS PRO (Facilitation through Aggrastat By drOpping or shortening Infusion Line in patients with ST-segment elevation myocardial infarction compared to or on top of PRasugrel given at loading dOse) trial</title><author>Valgimigli, Marco ; Tebaldi, Matteo ; Campo, Gianluca ; Gambetti, Stefania ; Bristot, Laura ; Monti, Monia ; Parrinello, Giovanni ; Ferrari, Roberto</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-p140t-c173316d8efc0825848c5de79aff391933926b4ac812c986eb2e84ab2e67cc353</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2012</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Angioplasty, Balloon, Coronary - adverse effects</topic><topic>Angioplasty, Balloon, Coronary - instrumentation</topic><topic>Drug Administration Schedule</topic><topic>Drug Therapy, Combination</topic><topic>Female</topic><topic>Humans</topic><topic>Infusions, Intravenous</topic><topic>Injections, Intravenous</topic><topic>Italy</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - blood</topic><topic>Myocardial Infarction - therapy</topic><topic>Piperazines - administration & dosage</topic><topic>Platelet Aggregation - drug effects</topic><topic>Platelet Aggregation Inhibitors - administration & dosage</topic><topic>Platelet Function Tests</topic><topic>Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors</topic><topic>Platelet Glycoprotein GPIIb-IIIa Complex - metabolism</topic><topic>Prasugrel Hydrochloride</topic><topic>Predictive Value of Tests</topic><topic>Prospective Studies</topic><topic>Purinergic P2Y Receptor Antagonists - administration & dosage</topic><topic>Stents</topic><topic>Thiophenes - administration & dosage</topic><topic>Ticlopidine - administration & dosage</topic><topic>Ticlopidine - analogs & derivatives</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>Tyrosine - administration & dosage</topic><topic>Tyrosine - analogs & derivatives</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Valgimigli, Marco</creatorcontrib><creatorcontrib>Tebaldi, Matteo</creatorcontrib><creatorcontrib>Campo, Gianluca</creatorcontrib><creatorcontrib>Gambetti, Stefania</creatorcontrib><creatorcontrib>Bristot, Laura</creatorcontrib><creatorcontrib>Monti, Monia</creatorcontrib><creatorcontrib>Parrinello, Giovanni</creatorcontrib><creatorcontrib>Ferrari, Roberto</creatorcontrib><creatorcontrib>FABOLUS PRO Investigators</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>MEDLINE - Academic</collection><jtitle>JACC. Cardiovascular interventions</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Valgimigli, Marco</au><au>Tebaldi, Matteo</au><au>Campo, Gianluca</au><au>Gambetti, Stefania</au><au>Bristot, Laura</au><au>Monti, Monia</au><au>Parrinello, Giovanni</au><au>Ferrari, Roberto</au><aucorp>FABOLUS PRO Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prasugrel versus tirofiban bolus with or without short post-bolus infusion with or without concomitant prasugrel administration in patients with myocardial infarction undergoing coronary stenting: the FABOLUS PRO (Facilitation through Aggrastat By drOpping or shortening Infusion Line in patients with ST-segment elevation myocardial infarction compared to or on top of PRasugrel given at loading dOse) trial</atitle><jtitle>JACC. Cardiovascular interventions</jtitle><addtitle>JACC Cardiovasc Interv</addtitle><date>2012-03</date><risdate>2012</risdate><volume>5</volume><issue>3</issue><spage>268</spage><epage>277</epage><pages>268-277</pages><eissn>1876-7605</eissn><abstract>The authors sought to compare the effect on inhibition of platelet aggregation (IPA) of prasugrel therapy versus tirofiban bolus with or without a post-bolus short drug infusion in ST-segment elevation myocardial infarction (STEMI) patients.
The degree and rapidity of IPA after prasugrel alone with or without concomitant glycoprotein IIb/IIIa inhibition in STEMI patients is unknown.
A total of 100 STEMI patients randomly received prasugrel 60 mg versus 25 μg/kg tirofiban bolus with or without post-bolus 2-h infusion of tirofiban, with or without concomitant prasugrel. IPA at light transmission aggregometry was performed throughout 24 h. The primary endpoint was IPA stimulated with 20 μmol/l adenosine diphosphate (ADP) at 30 min.
At 30 min, patients in the prasugrel group showed a significantly lower IPA to 20 μmol/l ADP stimulation as compared with tirofiban-treated patients (36 ± 35 vs. 87 ± 31, p < 0.0001). Similarly, patients taking prasugrel showed a suboptimal degree of platelet inhibition for at least 2 h compared with tirofiban patients. Post-bolus tirofiban infusion was necessary to maintain a high level of IPA beyond 1 h after bolus administration if concomitant clopidogrel was given, whereas the bolus-only tirofiban and concomitant prasugrel led to the higher and more consistent IPA levels after both ADP and thrombin receptor-activating peptide stimuli than either therapy alone.
Our study shows that prasugrel administration leads to a suboptimal IPA for at least 2 h in STEMI patients. Yet, prasugrel, given in association with a bolus only of glycoprotein IIb/IIIa inhibitor, obviates the need of post-bolus infusion and almost completely abolishes residual variability of IPA after treatment. (Facilitation through Aggrastat By drOpping or shortening Infusion Line in patients with ST-segment elevation myocardial infarction compared to or on top of PRasugrel given at loading dOse [The FABOLUS PRO trial]; NCT01336348).</abstract><cop>United States</cop><pmid>22440491</pmid><doi>10.1016/j.jcin.2012.01.006</doi><tpages>10</tpages></addata></record> |
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| subjects | Aged Aged, 80 and over Angioplasty, Balloon, Coronary - adverse effects Angioplasty, Balloon, Coronary - instrumentation Drug Administration Schedule Drug Therapy, Combination Female Humans Infusions, Intravenous Injections, Intravenous Italy Male Middle Aged Myocardial Infarction - blood Myocardial Infarction - therapy Piperazines - administration & dosage Platelet Aggregation - drug effects Platelet Aggregation Inhibitors - administration & dosage Platelet Function Tests Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors Platelet Glycoprotein GPIIb-IIIa Complex - metabolism Prasugrel Hydrochloride Predictive Value of Tests Prospective Studies Purinergic P2Y Receptor Antagonists - administration & dosage Stents Thiophenes - administration & dosage Ticlopidine - administration & dosage Ticlopidine - analogs & derivatives Time Factors Treatment Outcome Tyrosine - administration & dosage Tyrosine - analogs & derivatives |
| title | Prasugrel versus tirofiban bolus with or without short post-bolus infusion with or without concomitant prasugrel administration in patients with myocardial infarction undergoing coronary stenting: the FABOLUS PRO (Facilitation through Aggrastat By drOpping or shortening Infusion Line in patients with ST-segment elevation myocardial infarction compared to or on top of PRasugrel given at loading dOse) trial |
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