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Net clinical benefit of prehospital glycoprotein IIb/IIIa inhibitors in patients with ST-elevation myocardial infarction and high risk of bleeding: effect of tirofiban in patients at high risk of bleeding using CRUSADE bleeding score.
J Invasive Cardiol. 2012 Mar; 24(3):84-9.JI

Abstract

AIMS

The aim of this subanalysis was to assess the net clinical effect of prehospital administration of tirofiban in ST-elevation myocardial infarction (STEMI) patients with high risk of bleeding.

METHODS

This is a retrospective subanalysis of the On- TIME 2 trial, a multicenter, controlled randomized trial of the effects of high bolus-dose tirofiban given in the ambulance in STEMI patients. Tirofiban was given on top of aspirin, heparin, and clopidogrel. According to CRUSADE, patients with a moderate to very high baseline risk of bleeding were defined as high risk and patients with a very low or low baseline bleeding risk were defined as low risk. Primary endpoint was net adverse clinical events (NACE) at 30 days (defined as the combined incidence of death, recurrent myocardial infarction, urgent target vessel revascularization, stroke, or non-coronary artery bypass graft [CABG]-related major bleeding).

RESULTS

Of 1309 patients, a high bleeding risk was present in 291 patients (22.2%). In these high-risk bleeding patients, tirofiban significantly improved after percutaneous coronary intervention (PCI) ST-segment resolution. Administration of tirofiban in high-risk bleeding patients showed no difference in 30-day major adverse cardiac events (MACE) (9.4% vs 13.0%; P=.330; relative risk [RR], 0.72; 95% confidence interval [CI], 0.37-1.39). However, pretreatment with tirofiban was associated with a nonsignificant increase in non-CABG related bleeding (8.6% vs 3.6%; P=.082; RR, 2.38; 95% CI, 0.90-6.39). The net clinical effect (30-day NACE) of tirofiban in this group was balanced (11.5% vs 15.2%; P=.365; RR, 0.76; 95% CI, 0.41-1.38).

CONCLUSION

Prehospital use of tirofiban in STEMI patients with high risk of bleeding improves post-PCI ST-segment resolution, but increases nonsignificantly the risk of non-CABG related bleeding. The net result is a balanced effect on 30-day NACE. Additional studies should clarify how use of bleeding risk scores should modify medical (antiplatelet) therapy.

Authors+Show Affiliations

Isala klinieken, Department of Cardiology, Zwolle, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

22388296

Citation

Hermanides, Renicus S., et al. "Net Clinical Benefit of Prehospital Glycoprotein IIb/IIIa Inhibitors in Patients With ST-elevation Myocardial Infarction and High Risk of Bleeding: Effect of Tirofiban in Patients at High Risk of Bleeding Using CRUSADE Bleeding Score." The Journal of Invasive Cardiology, vol. 24, no. 3, 2012, pp. 84-9.
Hermanides RS, Ottervanger JP, ten Berg JM, et al. Net clinical benefit of prehospital glycoprotein IIb/IIIa inhibitors in patients with ST-elevation myocardial infarction and high risk of bleeding: effect of tirofiban in patients at high risk of bleeding using CRUSADE bleeding score. J Invasive Cardiol. 2012;24(3):84-9.
Hermanides, R. S., Ottervanger, J. P., ten Berg, J. M., Gosselink, A. T., van Houwelingen, G., Dambrink, J. H., Stella, P. R., Hamm, C., & van 't Hof, A. W. (2012). Net clinical benefit of prehospital glycoprotein IIb/IIIa inhibitors in patients with ST-elevation myocardial infarction and high risk of bleeding: effect of tirofiban in patients at high risk of bleeding using CRUSADE bleeding score. The Journal of Invasive Cardiology, 24(3), 84-9.
Hermanides RS, et al. Net Clinical Benefit of Prehospital Glycoprotein IIb/IIIa Inhibitors in Patients With ST-elevation Myocardial Infarction and High Risk of Bleeding: Effect of Tirofiban in Patients at High Risk of Bleeding Using CRUSADE Bleeding Score. J Invasive Cardiol. 2012;24(3):84-9. PubMed PMID: 22388296.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Net clinical benefit of prehospital glycoprotein IIb/IIIa inhibitors in patients with ST-elevation myocardial infarction and high risk of bleeding: effect of tirofiban in patients at high risk of bleeding using CRUSADE bleeding score. AU - Hermanides,Renicus S, AU - Ottervanger,Jan Paul, AU - ten Berg,Jurrien M, AU - Gosselink,A T Marcel, AU - van Houwelingen,Gert, AU - Dambrink,Jan-Henk E, AU - Stella,Pieter R, AU - Hamm,Christian, AU - van 't Hof,Arnoud W J, AU - ,, PY - 2012/3/6/entrez PY - 2012/3/6/pubmed PY - 2012/9/12/medline SP - 84 EP - 9 JF - The Journal of invasive cardiology JO - J Invasive Cardiol VL - 24 IS - 3 N2 - AIMS: The aim of this subanalysis was to assess the net clinical effect of prehospital administration of tirofiban in ST-elevation myocardial infarction (STEMI) patients with high risk of bleeding. METHODS: This is a retrospective subanalysis of the On- TIME 2 trial, a multicenter, controlled randomized trial of the effects of high bolus-dose tirofiban given in the ambulance in STEMI patients. Tirofiban was given on top of aspirin, heparin, and clopidogrel. According to CRUSADE, patients with a moderate to very high baseline risk of bleeding were defined as high risk and patients with a very low or low baseline bleeding risk were defined as low risk. Primary endpoint was net adverse clinical events (NACE) at 30 days (defined as the combined incidence of death, recurrent myocardial infarction, urgent target vessel revascularization, stroke, or non-coronary artery bypass graft [CABG]-related major bleeding). RESULTS: Of 1309 patients, a high bleeding risk was present in 291 patients (22.2%). In these high-risk bleeding patients, tirofiban significantly improved after percutaneous coronary intervention (PCI) ST-segment resolution. Administration of tirofiban in high-risk bleeding patients showed no difference in 30-day major adverse cardiac events (MACE) (9.4% vs 13.0%; P=.330; relative risk [RR], 0.72; 95% confidence interval [CI], 0.37-1.39). However, pretreatment with tirofiban was associated with a nonsignificant increase in non-CABG related bleeding (8.6% vs 3.6%; P=.082; RR, 2.38; 95% CI, 0.90-6.39). The net clinical effect (30-day NACE) of tirofiban in this group was balanced (11.5% vs 15.2%; P=.365; RR, 0.76; 95% CI, 0.41-1.38). CONCLUSION: Prehospital use of tirofiban in STEMI patients with high risk of bleeding improves post-PCI ST-segment resolution, but increases nonsignificantly the risk of non-CABG related bleeding. The net result is a balanced effect on 30-day NACE. Additional studies should clarify how use of bleeding risk scores should modify medical (antiplatelet) therapy. SN - 1557-2501 UR - https://www.unboundmedicine.com/medline/citation/22388296/Net_clinical_benefit_of_prehospital_glycoprotein_IIb/IIIa_inhibitors_in_patients_with_ST_elevation_myocardial_infarction_and_high_risk_of_bleeding:_effect_of_tirofiban_in_patients_at_high_risk_of_bleeding_using_CRUSADE_bleeding_score_ L2 - http://www.invasivecardiology.com/articles/net-clinical-benefit-prehospital-glycoprotein-iibiiia-inhibitors-patients-st-elevation-myoc DB - PRIME DP - Unbound Medicine ER -