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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/cdn\/css\/http\/css_Xg7z6oCTVgud_Q0huYz9x9iiD5H_2YPSJ5z2ZViSWdY.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EResults from the 3T\/2R study [\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00398463\u0026amp;atom=%2Fspmdc%2F8%2F6%2F23.atom\u0022\u003ENCT00398463\u003C\/a\u003E] demonstrated that the addition of tirofiban to standard therapy decreased the rate of myocardial infarction and resulted in a lower rate of major cardiovascular events 30 days after percutaneous coronary intervention compared with standard antiplatelet therapy alone in poor responders to aspirin or clopidogrel.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Emyocardial infarction\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Einterventional techniques \u0026amp; devices clinical trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EResults from the 3T\/2R study (\u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00398463\u0026amp;atom=%2Fspmdc%2F8%2F6%2F23.atom\u0022\u003ENCT00398463\u003C\/a\u003E) demonstrated that the addition of tirofiban to standard therapy decreased the rate of myocardial infarction (MI) and resulted in a lower rate of major cardiovascular events (MACE) 30 days after percutaneous coronary intervention (PCI) compared with standard antiplatelet therapy alone in poor responders to aspirin or clopidogrel.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EIndividual response to aspirin or clopidogrel varies considerably among patients. Prior studies have shown that patients who have a poor response to or are resistant to one or both of these medications are at higher risk for subsequent cardiovascular events, particularly after PCI. Adjunctive inhibition of platelet glycoprotein (GP) IIb\/IIIa receptors has been shown to reduce the overall risk of death or nonfatal MI 30 days after PCI [Topol EJ et al. \u003Cem\u003EN Engl J Med\u003C\/em\u003E 2001]. Tirofiban is a highly selective, short-acting inhibitor of fibrinogen binding to platelet GP IIb\/IIIa that inhibits \u003Cem\u003Eex vivo\u003C\/em\u003E platelet aggregation in response to a variety of agonists.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EThe main purpose of this study was to assess, in poor responders to oral antiplatelet therapy, whether tirofiban in addition to standard antiplatelet therapy can reduce the incidence of MI after elective coronary angioplasty compared with standard therapy alone.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThis was a randomized, double-blind, multicenter, placebo-controlled, proof-of-concept study in patients aged 18 to 75 years who were scheduled to undergo elective PCI for silent ischemia, stable angina, or low-risk non-ST-segment elevation acute coronary syndrome who were determined (using VerifyNow\u2122 Aspirin and P2Y12 point-of-care assays) to be poor responders to aspirin or clopidogrel. Aspirin poor response was defined as aspirin reaction units (ARU) \u0026gt;550, and clopidogrel resistance as \u0026lt;40% platelet inhibition. The primary study endpoint was troponin I\/T elevation \u0026gt;3X ULN in one or more blood samples within 48 hours after PCI. Secondary endpoints included CK-MB mass elevation \u0026gt;1X, 3X, or 5X ULN; MACE; or stent thrombosis based on ARC classification. All patients received heparin or bivalirudin, aspirin, and 300 mg (6 hours before PCI) or 600 mg (2 hours before PCI) clopidogrel. Patients in the tirofiban arm (n=132) also received tirofiban 25 \u03bcg\/kg (high-bolus dose regimen), administered as a 3-minute bolus followed by a 14 to 24-hour 0.15-\u03bcg\/kg\/min infusion. A full discussion of the rationale and study protocol has already been published [Valgimigli M et al. \u003Cem\u003ECardiovasc Drugs Ther\u003C\/em\u003E 2008].\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EA total of 263 of 1277 patients who were scheduled for elective PCI met criteria for inclusion in the study. Within 48 hours after PCI, troponin I\/T values \u0026gt;3X ULN were found in 35.1% of patients who were treated with standard care versus 20.4% of the patients who were treated with standard care plus tirofiban (relative risk reduction [RRR] 42%; 95% CI, 12 to 61; p=0.009). Similar benefit for add-on treatment with tirofiban was seen in both aspirin and clopidogrel poor responders separately.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EAt 30 days, the MACE rate was significantly lower in patients who were treated with add-on tirofiban (21%) versus those who were treated with standard care only (37%; p=0.006), with the difference being driven almost entirely by the rate of MI (\u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/6\/23\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u002230-Day Outcomes Efficacy Endpoints.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-780847184\u0022 data-figure-caption=\u002230-Day Outcomes Efficacy Endpoints.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/6\/23\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/6\/23\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/8\/6\/23\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/11111\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-8\u0022 class=\u0022first-child\u0022\u003E30-Day Outcomes Efficacy Endpoints.\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-9\u0022\u003ECK-MB levels were lower in patients who were treated with add-on tirofiban but were significantly different from placebo only for those who had levels \u0026gt;1X ULN (RRR 62%; p=0.001). Safety results were similar in both groups. There was no major bleeding. The rate of minor bleeding was very low (p=0.99) and did not differ between the two groups.\u003C\/p\u003E\n         \u003Cp id=\u0022p-10\u0022\u003EA recently published study [Bonello L. \u003Cem\u003EJ Am Coll Cardiol\u003C\/em\u003E 2008] demonstrated that administration of additional clopidogrel (600 mg every 24 hours for 1 to 3 doses), guided by the vasodilator-stimulated phosphoprotein index, is an effective method to reduce MACE following PCI in patients with clopidogrel resistance. Further studies are needed to compare these 2 successful strategies (additional clopidogrel vs high-bolus dose tirofiban) to manage patients who have a poor response to antiplatelet therapy who are undergoing PCI. Given the difference in timing that is required to achieve an adequate antiplatelet effect, consideration of the clinical circumstances may dictate which strategy is preferred.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2008 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/8\/6\/23.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzmd8q\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzmd8q\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}