Korean Circ J.  2003 Jul;33(7):559-567. 10.4070/kcj.2003.33.7.559.

The Long-Term Clinical Outcomes of Low Molecular Weight Heparin Combined with Platelet Glycoprotein IIb/IIIa Inhibitor in Patients with Acute Coronary Syndrome

• Kim JH
• Jeong MH
• Rhew JY
• Yang B
• Sim DS
• Lim SY
• Hong YJ
• Park OY
• Park WS
• Kim W
• Ahn YK
• Moon Y
• Cho JG
• Chun J

• KMID: 2093885
• DOI: http://doi.org/10.4070/kcj.2003.33.7.559

Abstract

BACKGROUND AND OBJECTIVES
Platelet activation and aggregation, with resultant arterial thrombus formation, play pivotal roles in the pathophysiology of acute coronary syndrome (ACS). The efficacy of tirofiban, a specific inhibitor of the platelet glycoprotein IIb/IIIa receptor, combined with heparin, or low molecular heparin (LMWH), in the management of ACS were evaluated. SUBJECTS AND MEHTODS: One hundred seventeen patients (60.8+/-10.9 years, 76 male), with unstable angina or non-ST elevation myocardial infarction, who had ST-T changes and elevated troponin, were divided into 4 groups : Group I (n=30 : heparin alone), Group II (n=28 : LMWH, dalteparin alone), Group III (n=29 : tirofiban combined with heparin) and Group IV (n=30 : tirofiban with LMWH). The major adverse cardiac events (MACE) among the 4 groups, during 6-month clinical follow-ups, were compared.
RESULTS
Percutaneous coronary intervention, or a coronary artery bypass graft, was performed in 23, 19, 19 and 22 patients from Groups I, II, III and IV, respectively (p=0.87). A minor bleeding complication developed in 2 (6.7%), 1 (3.6%), 1 (3.4%) and 2 patients (6.7%) in groups I, II, III and IV, respectively (p=0.79). During the six-month follow-up MACE occurred in 7 (30.4%), 6 (31.6%), 3 (15.8%) and 4 patients (18.2%) in groups I, II, III and IV, respectively (p=0.02 : Group I and II vs. Group III and IV).
CONCLUSION
Tirofiban combined with LMWH is safe and may improve the long-term prognosis of patients with ACS.

Keyword

Myocardial infarction; Thrombosis; Platelets; Angioplasty; Prognosis

MeSH Terms

Acute Coronary Syndrome*
Angina, Unstable
Angioplasty
Blood Platelets*
Coronary Artery Bypass
Dalteparin
Follow-Up Studies
Glycoproteins*
Hemorrhage
Heparin
Heparin, Low-Molecular-Weight*
Humans
Myocardial Infarction
Percutaneous Coronary Intervention
Platelet Activation
Prognosis
Thrombosis
Transplants
Troponin
Dalteparin
Glycoproteins
Heparin
Heparin, Low-Molecular-Weight
Troponin