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1.
São Paulo med. j ; São Paulo med. j;134(3): 199-204, tab
Artigo em Inglês | LILACS | ID: lil-785805

RESUMO

CONTEXT AND OBJECTIVES: Glycoprotein inhibitors (abciximab, eptifibatide and tirofiban) are used in patients with unstable angina and non-ST-segment elevation myocardial infarction before percutaneous coronary intervention. Of these, tirofiban is the least effective. We hypothesized that the response to tirofiban might be associated with glycoprotein gene mutations. DESIGN AND SETTING: Prospective study at Emergency Unit, Heart Institute (InCor), University of São Paulo. METHOD: Intrahospital evolution and platelet aggregation in response to tirofiban were analyzed in relation to four glycoprotein mutations in 50 patients indicated for percutaneous coronary intervention: 17 (34%) with unstable angina and 33 (66%) with non-ST-segment elevation myocardial infarction. Platelet aggregation was analyzed using the Born method. Blood samples were obtained before and one hour after tirofiban infusion. Glycoproteins Ia (807C/T ), Ib (Thr/Met) , IIb (Ile/Ser ) and IIIa (PIA ) were the mutations selected. RESULTS: Hypertension, dyslipidemia, diabetes, smoking, previous coronary artery disease and stroke were similar between the groups. Mutant glycoprotein IIIa genotypes had lower platelet aggregation before tirofiban administration than that of the wild genotype (41.0% ± 22.1% versus 55.9% ± 20.8%; P = 0.035). Mutant glycoprotein IIIa genotypes correlated moderately with lower platelet inhibition (r = -0.31; P = 0.030). After tirofiban administration, platelet glycoprotein Ia, Ib, IIb and IIIa mutations did not influence the degree of inhibition of platelet aggregation or intrahospital mortality. CONCLUSIONS: Mutations of glycoproteins Ia, Ib, IIb and IIIa did not influence platelet aggregation in response to tirofiban in patients with unstable angina and non-ST-segment elevation myocardial infarction.


RESUMO CONTEXTO E OBJETIVOS: Inibidores da glicoproteína (abciximab, eptifibatide, tirofiban) são utilizados em pacientes com angina instável e infarto do miocárdio sem elevação do segmento ST (IAMSSST) antes da intervenção coronária percutânea. Dentre eles, o tirofiban é o menos eficaz. Nossa hipótese é que a resposta ao tirofiban possa estar associada a mutações no gene da glicoproteína. DESENHO E LOCAL: Estudo prospectivo na Unidade de Emergência do Instituto do Coração (InCor), Universidade de São Paulo (USP). MÉTODOS: Foram analisadas a evolução intra-hospitalar e agregabilidade plaquetária em resposta ao tirofiban de 4 mutações da glicoproteína em 50 pacientes com indicação para intervenção coronária percutânea, 17 (34%) com angina instável e 33 (66%) com IAMSSST. A agregação plaquetária foi analisada pelo método de Born. Amostras de sangue foram obtidas antes e uma hora após infusão do tirofiban. As glicoproteínas Ia (807C/T ), Ib (Thr/Met ), IIb (Ile/Ser ) e IIIa (PIA ) foram as mutações selecionadas. RESULTADOS: Hipertensão, dislipidemia, diabetes, tabagismo, doença coronariana e acidente vascular cerebral prévios foram semelhantes entre os grupos. Observou-se menor agregabilidade plaquetária dos genótipos mutantes da glicoproteína IIIa antes da administração de tirofiban do genótipo selvagem (41% ± 22% versus 56% ± 21%; P = 0,035). Genótipos mutantes da glicoproteína IIIa correlacionaram-se moderadamente com menor inibição plaquetária (r = -0,31; P = 0,030). Após a administração tirofiban, as mutações das glicoproteínas Ia, Ib, IIb, e IIIa não influenciaram o grau de inibição da agregação plaquetária e mortalidade intra-hospitalar. CONCLUSÕES: Mutações das glicoproteínas Ia, Ib, IIb e IIIa não influenciaram a agregação plaquetária em resposta ao tirofiban nos pacientes com angina instável e IAMSSST.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Tirosina/análogos & derivados , Inibidores da Agregação Plaquetária/uso terapêutico , Glicoproteínas da Membrana de Plaquetas/genética , Síndrome Coronariana Aguda/tratamento farmacológico , Mutação , Peptídeos/uso terapêutico , Tirosina/uso terapêutico , Fragmentos Fab das Imunoglobulinas/uso terapêutico , Agregação Plaquetária/efeitos dos fármacos , Agregação Plaquetária/genética , Reação em Cadeia da Polimerase , Estudos Prospectivos , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidores , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/genética , Síndrome Coronariana Aguda/genética , Abciximab , Tirofibana , Eptifibatida , Genótipo , Angina Instável/genética , Angina Instável/tratamento farmacológico , Anticorpos Monoclonais/uso terapêutico
2.
Sao Paulo Med J ; 134(3): 199-204, 2016 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-26786608

RESUMO

CONTEXT AND OBJECTIVES: Glycoprotein inhibitors (abciximab, eptifibatide and tirofiban) are used in patients with unstable angina and non-ST-segment elevation myocardial infarction before percutaneous coronary intervention. Of these, tirofiban is the least effective. We hypothesized that the response to tirofiban might be associated with glycoprotein gene mutations. DESIGN AND SETTING: Prospective study at Emergency Unit, Heart Institute (InCor), University of São Paulo. METHOD: Intrahospital evolution and platelet aggregation in response to tirofiban were analyzed in relation to four glycoprotein mutations in 50 patients indicated for percutaneous coronary intervention: 17 (34%) with unstable angina and 33 (66%) with non-ST-segment elevation myocardial infarction. Platelet aggregation was analyzed using the Born method. Blood samples were obtained before and one hour after tirofiban infusion. Glycoproteins Ia (807C/T ), Ib (Thr/Met) , IIb (Ile/Ser ) and IIIa (PIA ) were the mutations selected. RESULTS: Hypertension, dyslipidemia, diabetes, smoking, previous coronary artery disease and stroke were similar between the groups. Mutant glycoprotein IIIa genotypes had lower platelet aggregation before tirofiban administration than that of the wild genotype (41.0% ± 22.1% versus 55.9% ± 20.8%; P = 0.035). Mutant glycoprotein IIIa genotypes correlated moderately with lower platelet inhibition (r = -0.31; P = 0.030). After tirofiban administration, platelet glycoprotein Ia, Ib, IIb and IIIa mutations did not influence the degree of inhibition of platelet aggregation or intrahospital mortality. CONCLUSIONS: Mutations of glycoproteins Ia, Ib, IIb and IIIa did not influence platelet aggregation in response to tirofiban in patients with unstable angina and non-ST-segment elevation myocardial infarction.


Assuntos
Síndrome Coronariana Aguda/tratamento farmacológico , Mutação , Inibidores da Agregação Plaquetária/uso terapêutico , Glicoproteínas da Membrana de Plaquetas/genética , Tirosina/análogos & derivados , Abciximab , Síndrome Coronariana Aguda/genética , Idoso , Angina Instável/tratamento farmacológico , Angina Instável/genética , Anticorpos Monoclonais/uso terapêutico , Eptifibatida , Feminino , Genótipo , Humanos , Fragmentos Fab das Imunoglobulinas/uso terapêutico , Masculino , Pessoa de Meia-Idade , Peptídeos/uso terapêutico , Agregação Plaquetária/efeitos dos fármacos , Agregação Plaquetária/genética , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidores , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/genética , Reação em Cadeia da Polimerase , Estudos Prospectivos , Tirofibana , Tirosina/uso terapêutico
3.
Am J Ther ; 23(1): e298-9, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-24368608

RESUMO

Eptifibatide is a commonly and widely used drug for management of acute coronary syndrome and during percutaneous coronary intervention. It is usually well tolerated with no major adverse effects. We report a rare case of life-threatening thrombocytopenia secondary to eptifibatide along with a literature review of available evidence.


Assuntos
Peptídeos/efeitos adversos , Inibidores da Agregação Plaquetária/efeitos adversos , Complexo Glicoproteico GPIIb-IIIa de Plaquetas/antagonistas & inibidores , Trombocitopenia/induzido quimicamente , Idoso , Eptifibatida , Humanos , Masculino
4.
Bol Asoc Med P R ; 106(2): 19-24, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25065046

RESUMO

UNLABELLED: One of the most common indications of Eptifibatide, a GP IIb/IIIa inhibitor, is non-ST segment elevation myocardial infarction (NSTEMI) due to its great antiplatelet activity. The aim of this study was to find out if there are gender discrepancies when comparing complications in Hispanics treated th Eptifibatide. METHODS: A cross-sectional study. 116 medical records with diagnosis ofNSTEMI managed with Eptifibatide during 2010-2012 were included. Bleeding, thrombocytopenia, new ischemia, anemia and death were variables compared. RESULTS: The most common complication was death. There were four cases of bleeding, all of them occurred in the female gender, reaching a statistically significant difference compared to male gender (p = 0.0173); 8% of patients had thrombocytopenia; 9% had new ischemia during hospitalization; 13% died; 19% of patients developed anemia including the four cases of bleeding. CONCLUSION: Bleeding occurred only in women, and this difference was statistically significant when compared to males. More studies emphasizing the differences in Eptifibatide complications by gender are needed. Furthermore, it would be important to compare these results to non-Hispanic women. The difference found in the other complications analyzed was not statistically significant.


Assuntos
Hispânico ou Latino , Peptídeos/efeitos adversos , Inibidores da Agregação Plaquetária/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Eptifibatida , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Fatores Sexuais , Adulto Jovem
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