| Objective To explore the effectiveness and safety of small-dose tirofiban in emergency coronary intervention therapy to acute myocardial infarction(AMI) via comparing with bleeding, ischemia, thrombocytopenia and so so events after using small-dose tirofiban and conventional-dose tirofiban in patient with AMI being involved in emergency coronary intervention therapy.Methods A total of 300 patients with AMI received the emergency coronary intervention therapy in Cardiology Ward 4 of Tangshan Gongren Hospital between November 2011 and September 2014 were enrolled and randomly divided into tirofiban conventional-dose group(105 patients), 1/2 dose group(103 patients) and 1/3 dose group(92 patients). The emergency coronary angiography and PCI were performed within 90 minutes. Tirofiban hydrochloride 10μg/kg, 5μg/kg and 3.3μg/kg of load capacity were given for intravenous injection to conventional-dose group, 1/2 dose group and 1/3 dose group, respectively before operation. A rate of continuous intravenous pumping of 0.15μg/(kg. min) was arranged for conventional-dose group, 1/2 dose group and 1/3 dose group and 0.075μg/(kg. min) and 0.05μg/(kg. min) for 1/2 dose group for 48 h. Wanmaishu(low-molecular-weight heparin calcium injection) 4100 Axa IU was given 6 hours after emergency coronary intervention therapy, hypodermic injection in every 12 hours for 7 days. Collect blood samples and record the result, Record the TIMI blood flow classification after PCI. The platelet count will test again after 12 h. Echocardiography(UCG) examination was conducted within 24 hours after operation. Rrecord occurrence of major adverse cardiovascular events(MACE), bleeding events were closely observed and recorded.Comparision of MACE in 1 month follow-up after operation follow-up.Data were typed in by EXCEL 2007; statistical analysis was carried out using SPSS17.0 software; dose data were expressed by`x±s; comparison among groups adopted one-way analysis of variance(ANOVA) and enumeration data adopted c2 test. The difference has statistical significance(P<0.05). Pairwise comparison adopted c2 partition, P value was amended as 0.0167. The difference has statistical significance(P<0.0167).Results 1 Two patients had mild thrombocytopenia without bleeding tendency only occurred in the conventional-dose group among three groups. The thrombocytopenia was not occurred in both 1/2 and 1/3 dose group. 2 Among 29 patients with bleeding, With respect to the degree of bleeding, there was no statistical difference(P>0.05) among three groups. By comparing of mild bleeding there was no statistical difference(P>0.0167) after compared the conventional-group with 1/2 group and 1/3 group; and there was no statistical difference(P>0.0167) in comparison between 1/2 dose group and 1/3 dose group. The incidence of total bleeding events was 15.24%(16 patients) in the conventional-dose group, 8.73%(9 patients) in the 1/2 dose group and 5.43%(4 patients) in the 1/3 dose group. There was a statistical difference(P=0.033) in the total bleeding events among three groups. For the pairwise comparison to the total bleeding events among three groups, there was no significantly statistical difference(P>0.05) after compared the conventional-dose group with 1/2 dose group; there was no statistical difference(P>0.05) after compared the 1/2 dose group with 1/3 dose group; there was a significant difference(P=0.012) after compared the conventional-dose group with 1/3 dose group.3 A total of 42 patients had happened the ischemic events and none had new myocardial infarction and cardiac death. There was no statistical difference(P>0.05) regarding to severe arrhythmia after compared with those three groups while there was a statistical difference(P=0.024) regarding to comparison of post-infarct angina. With respect to the pairwise comparison of post-infarct angina among three groups, there was no significantly statistical significance(P>0.0167) after compared the conventional-dose group with 1/2 dose group; there was no significantly statistical significance(P>0.0167) after compared the 1/2 dose group with 1/3 dose group; and there was a statistical significance(P=0.013) after compared the conventional-dose group with 1/3 dose group. There was a statistical significance(P=0.045) regarding to comparison of total MACE events among three groups. For the pairwise comparison of total MACE events, there was no significantly statistical significance(P>0.0167) between the conventional-dose group and 1/2 dose group, 1/2 dose group and 1/3 dose group. But there was a statistical significance(P=0.010) after compared the conventional-dose group with 1/3 dose group. 4 By comparing with immediate TIMI blood flow after emergency coronary intervention therapy among three groups, there was no significantly statistical significance(P>0.05).5 By compared the MACE of one month follow-up, there was no significantly statistical significance(P>0.05) among three group, there was also no significantly statistical significance(P>0.0167) in comparation between groups.Conclusion 1 Small-dose tirofiban is unable to reduce the occurrence of thrombocytopenia in combination of tirofiban after emergency coronary intervention therapy. 2 1/2 dose of tirofiban won’t increase the occurrence of bleeding or ischemic events, even with a tendency of decreasing the bleeding events. It is safe and effective in clinical practice. 3 1/3 dose of tirofiban can effectively reduce the occurrence of bleeding events after emergency coronary intervention therapy; increase the ischemic events mainly in post-infarct angina; but not increase the incidence of malignant arrhythmia, AMI and cardiac death. Therefore, it is more suitable to high-risk bleeding population.4 Reduced load capacity of tirofiban prior to emergency coronary intervention therapy won’t affect postoperative immediate TIMI blood flow. |
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