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Thrombosis and thromboembolism - part 6

Để đánh giá các ảnh hưởng của abciximab thấp nguy cơ bệnh nhân trải qua PCI, đánh giá của PTCA để cải thiện kết quả dài hạn bởi abciximab phong tỏa GP IIbIIIa (EPILOG) thử nghiệm phân ngẫu nhiên 2.792 bệnh nhân được điều trị bằng aspirin để tiêu chuẩn liều lượng | Antithrombotic Therapy During PCI 177 death reinfarction or urgent target vessel revascularization at 30 days in patients treated with abciximab 4.9 versus placebo 10.3 22 . There was no difference in 6-month restenosis between the two groups 22 . To evaluate the effect of abciximab in low-risk patients undergoing PCI the Evaluation of PTCA to Improve Long-Term Outcome by abciximab GP IIb-IIIa blockade EPILOG trial randomly assigned 2792 patients who were treated with aspirin to standard-dose weight-adjusted 100 U kg bolus heparin and placebo standard-dose weight-adjusted heparin and abciximab or low-dose weight-adjusted 70 U kg bolus heparin. The 30-day composite event rate was significantly lower p 0.001 in patients treated with abciximab and low-dose 5.2 or standard-dose 5.4 heparin than in patients treated with standarddose heparin and placebo 11.7 23 . Bleeding complications were lowest in patients treated with abciximab and low-dose weight-adjusted heparin. The effect of GPIIb-IIIa inhibitors has been more variable in patients undergoing saphenous vein graft intervention. While one study suggested a beneficial effect with abciximab in patients undergoing SVG angioplasty 24 a larger study failed to demonstrate a convincing reduction in these patients at high risk for microembolization 25 . Bailout abciximab is often given during or just after PCI for the presence of residual dissection thrombus or suboptimal results 26 although its value has not been demonstrated in prospective studies. The EPISTENT trial randomly assigned 2399 patients with ischemic CAD to stenting plus placebo stenting plus abciximab or balloon PTCA plus abcixi-mab 27 and found that the primary 30-day endpoint a combination of death MI or need for urgent revascularization occurred in 10.8 of patients in the stent plus placebo group 5.3 of patients in the stent plus abciximab group hazard ratio 0.48 p 0.001 and 6.9 of patients in the balloon plus abciximab group 0.63 p 0.007 27 . The primary