Textbook of Interventional Cardiovascular Pharmacology phần 10

để giao hàng có thể là một vài trong nhiều lý do chịu trách nhiệm về thất bại của nghiên cứu. Dữ liệu từ các đánh giá thử nghiệm lâm sàng tẩy rửa paclitaxel Stent châu Âu, trong đó một Nấu | 580 Anticoagulants in peripheral vascular interventions Combination therapy Combination therapy with a thrombolytic agent and GPIIb IIIa inhibitor has been studied in acute MI. Various randomized trials TAMI-8 IMPACT INTRO AMI TIMI-14 SPEED GUSTO V in the coronary literature have shown that combination therapy reduced thrombolysis time and permitted a reduction of thrombolytic doses by 25 to 50 of the normal dose. This is explained by the fact that thrombus is composed of both fibrin and platelets. Thrombolytics only address the fibrin component of acute thrombus. Furthermore thrombolytics may actually activate platelets directly resulting in additional thrombus formation. Therefore the addition of GPIIb IIIa inhibition facilitates the efficiency of the thrombolytic agent. It is also known that GPIIb IIIa inhibition alone can actually dissolve platelet rich clot 41 42 43 . There are several small studies examining this concept of thrombolytic infusion with GPIIb IIIa inhibition to reduce lytic infusion time and improve efficacy as summarized below. This concept is not universally proven in these studies. A larger randomized trail is needed to examine this concept before a clinical practice recommendation can be made. Tepes et al. reported the first clinical experience with abcix-imab and urokinase combination therapy in the peripheral circulation 44 . Schweizer et al. used abciximab and rt-PA versus rt-PA with ASA in an 84 patient trial and found a significantly shorter duration of thrombolytic infusion was required to achieve lytic success in the combination group as well as improved clinical endpoints of less re-hospitalization re-intervention and amputation compared to ASA and heparin 45 . Duda et al. prospectively studied 70 patients in the PROMPT trial of UK and abciximab versus UK alone. The trial showed the combination therapy resulted in a decreased infusion time improved amputation free survival and improved open surgery free survival at 90 days 46 . .