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001-es BibID:	BIBFORM010419
Első szerző:	Giugliano, Robert P.
Cím:	Early versus delayed, provisional eptifibatide in acute coronary syndromes / Giugliano, R. P., White, J. A., Bode, C., Armstrong, P. W., Montalescot, G., Lewis, B. S., van't Hof, A., Berdan, L. G., Lee, K. L., Strony, J. T., Hildemann, S., Veltri, E., Van de Werf, F., Braunwald, E., Harrington, R. A., Califf, R. M., Newby, L. K., The EARLY ACS Investigators, Keltai M.
Dátum:	2009
ISSN:	1533-4406 (Electronic)
Megjegyzések:	Glycoprotein IIb/IIIa inhibitors are indicated in patients with acute coronary syndromes who are undergoing an invasive procedure. The optimal timing of the initiation of such therapy is unknown. METHODS: We compared a strategy of early, routine administration of eptifibatide with delayed, provisional administration in 9492 patients who had acute coronary syndromes without ST-segment elevation and who were assigned to an invasive strategy. Patients were randomly assigned to receive either early eptifibatide (two boluses, each containing 180 microg per kilogram of body weight, administered 10 minutes apart, and a standard infusion > or = 12 hours before angiography) or a matching placebo infusion with provisional use of eptifibatide after angiography (delayed eptifibatide). The primary efficacy end point was a composite of death, myocardial infarction, recurrent ischemia requiring urgent revascularization, or the occurrence of a thrombotic complication during percutaneous coronary intervention that required bolus therapy opposite to the initial study-group assignment ("thrombotic bailout") at 96 hours. The key secondary end point was a composite of death or myocardial infarction within the first 30 days. Key safety end points were bleeding and the need for transfusion within the first 120 hours after randomization. RESULTS: The primary end point occurred in 9.3% of patients in the early-eptifibatide group and in 10.0% in the delayed-eptifibatide group (odds ratio, 0.92; 95% confidence interval [CI], 0.80 to 1.06; P=0.23). At 30 days, the rate of death or myocardial infarction was 11.2% in the early-eptifibatide group, as compared with 12.3% in the delayed-eptifibatide group (odds ratio, 0.89; 95% CI, 0.79 to 1.01; P=0.08). Patients in the early-eptifibatide group had significantly higher rates of bleeding and red-cell transfusion. There was no significant difference between the two groups in rates of severe bleeding or nonhemorrhagic serious adverse events. CONCLUSIONS: In patients who had acute coronary syndromes without ST-segment elevation, the use of eptifibatide 12 hours or more before angiography was not superior to the provisional use of eptifibatide after angiography. The early use of eptifibatide was associated with an increased risk of non-life-threatening bleeding and need for transfusion.
Tárgyszavak:	Orvostudományok Klinikai orvostudományok idegen nyelvű folyóiratközlemény külföldi lapban Acute Coronary Syndrome Aged Angina Pectoris Angioplasty, Transluminal, Percutaneous Coronary Combined Modality Therapy Coronary Angiography Coronary Artery Bypass Drug Administration Schedule Drug Therapy, Combination Electrocardiography Female Hemorrhage Humans Infusions, Intravenous Kaplan-Meiers Estimate Male Middle Aged Myocardial Infarction Odds Ratio Peptides dosage Platelet Aggregation Inhibitors dosage Platelet Glycoprotein GPIIb-IIIa Complex inhibitors Thrombosis control Treatment Failure
Megjelenés:	The New England Journal of Medicine. - 360 : 21 (2009), p. 2176-2190. -
További szerzők:	White, Jennifer A. Bode, Christoph Armstrong, Paul W. Montalescot, Gilles Lewis, Basil S. van't Hof, Arnoud Berdan, Lisa G. Lee, Kerry L. Strony, John T. Hildemann, Steven Veltri, Enrico Werf, Frans, van de Braunwald, Eugene Harrington, Robert A. Califf, Robert M. Newby, L. Kristin Keltai Mátyás (1942-) (kardiológus) The EARLY ACS Investigators
Internet cím:	Intézményi repozitóriumban (DEA) tárolt változat
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