The Additive Value of Tirofiban Administered With the High-Dose Bolus in the Prevention of Ischemic Complications During High-Risk Coronary Angioplasty The ADVANCE Trial M. Valgimigli University of Ferrara Italy Erasmus MC, Thoraxcenter The Netherlands Department of Cardiology University of Ferrara
Department of Cardiology University of Ferrara. M. Valgimigli University of Ferrara Italy Erasmus MC, Thoraxcenter The Netherlands. The Additive Value of Tirofiban Administered With the High-Dose Bolus in the Prevention of Ischemic Complications During High-Risk Coronary Angioplasty - PowerPoint PPT Presentation
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The Additive Value of Tirofiban Administered Withthe High-Dose Bolus in the Prevention of Ischemic
Complications During High-Risk Coronary AngioplastyThe ADVANCE Trial
The Additive Value of Tirofiban Administered Withthe High-Dose Bolus in the Prevention of Ischemic
Complications During High-Risk Coronary AngioplastyThe ADVANCE Trial
Dr Schneider’sDr Schneider’s Hypothesis HypothesisBaseline platelet reactivity Baseline platelet reactivity is not uniform in patients is not uniform in patients undergoing PCIundergoing PCI
The higher the baseline The higher the baseline value, the worse the value, the worse the outcomeoutcome
Baseline platelet reactivity Baseline platelet reactivity is proportional to the clinical is proportional to the clinical status, lower in elective pts, status, lower in elective pts, higher in NSTEACS and higher in NSTEACS and highest in STEMI ptshighest in STEMI ptsTirofiban, at Restore Tirofiban, at Restore regimen, is just enough, regimen, is just enough, soon aftersoon after the bolus, to the bolus, to control platelet reactivity in control platelet reactivity in elective patients elective patients
To re-assess the efficacy of To re-assess the efficacy of Tirofiban when given at Tirofiban when given at SHDB on top of ADP SHDB on top of ADP receptor blockers in:receptor blockers in:
I.I. Elective patientsElective patients
II.II. NSTE-ACS patientsNSTE-ACS patients
Department of Cardiology, University of Ferrara,
Italy
AIMAIM
To re-assess the efficacy of To re-assess the efficacy of Tirofiban when given at Tirofiban when given at SHDB on top of ADP SHDB on top of ADP receptor blockers in receptor blockers in High-Risk::
No incidence of No incidence of major bleedingmajor bleeding
No RBC No RBC transfusionstransfusions
No severe No severe thrombocytopeniathrombocytopenia
One mild One mild thrombocytopenia thrombocytopenia in each groupin each groupMinor Bleeding
Placebo
Tirofiban
P=0.19
# P
atie
nts
0
2
4
6
8
10
12
14
16
18
20
Valgimigli et al. (2004) JACC 44:14-19
Department of Cardiology, University of Ferrara,
Italy
CONCLUSIONSCONCLUSIONS
Tirofiban when given at SHDB, immediately before high-risk PCIs, to patients who have been pre-treated with thienopyridines was:
• As safe asAs safe as• More effective thanMore effective than
UFH alone in the prevention of periprocedural ischemic complications
Our current findings, based on a limited and selected sample size, should be viewed as preliminary, thus giving input for further research in this field.