Abstract:
BACKGROUND:There are several new strategies proposed to improve the outcome of patients with ST-elevation myocardial infarction (STEMI). One approach is the resurgent use of facilitated percutaneous coronary interventions (PCI). Until recently, deciding whether immediate PCI after combined treatment (facilitated PCI) is more appropriate than delayed PCI (short time) has not been investigated. The aim of this study, therefore, was to investigate the outcomes in patients initially successfully treated pharmacologically and immediate PCI < 2 hr, and in patients initially successfully treated with pharmacological therapy and with delayed PCI (12-72 h). METHODS:451 reperfused STEMI patients, aged 18 to 75 years, class I-II Killip, with an acceptable echocardiographic window and admitted within 12 hs of the onset of symptoms were randomized into two groups. All patients had to have successful reperfusion, to receive the combination of a standard tirofiban infusion or abciximab plus half dose rtPA. Thereafter, patients were sub-grouped as follows:group 1 (immediate PCI) patients had PCI within 2 h; and group 2 (delayed PCI) patients in which PCI was performed after 12 hs and within 72 hs. RESULTS:The 225 reperfused (immediate-PCI) and 226 reperfused (delayed-PCI) patients (time from randomization to PCI 165 +/- 37 min in immediate PCI versus 45.1 +/- 20.2 h in delayed PCI group) showed similar results in ejection fraction, CK release and patency of the IRA. In addition, the delayed PCI group showed a significant reduction in ischemic events, restenosis and bleedings (P = 0.005, 0.01, 0.01 respectively) and significant reduced angiographic evidence of thrombus formation in the infarction-related artery (IRA) (p = 0.001). CONCLUSION:Our data suggest the safety and possible use of delayed facilitated PCI in patients with STEMI, and that delayed PCI in patients treated with combined lytic and IIb/IIIa inhibitors appears to be as effective and possibly superior (reduced ischemic events and repeat PCI) as immediate PCI. The patients in this study were successfully reperfused, with TIMI-3 flow and our data may not apply to patients with TIMI 0-2 flow. This strategy could allow transferring the reperfused patients and performing PCI after hours < 72 hours and not immediately, thereby reducing the number of urgent PCI and costs, obtaining similar results, but mostly causing less discomfort to the patient. Our results had to be interpreted with caution, because current guidelines do not recommend the combined therapy, but suggest further studies. The study was aimed to investigate the outcomes in patients initially successfully treated pharmacologically and immediate PCI < 2 h, and in patients initially successfully treated with pharmacological therapy and delayed PCI (12-72 h). All patients had to have successful reperfusion, to receive the combination of a standard abciximab or tirofiban infusion plus half dose rtPA. Similar results were observed in both groups. Delayed PCI group showed a significant lower incidence in restenosis (0.01), minor bleedings (0.005), ischemic events (0.01) and a reduced angiographic evidence of thrombus formation in IRA (0.001). Our data suggest the safety and possible use of delayed facilitated PCI in patients with STEMI. Our results had to be interpreted with caution, because current guidelines do not recommend the combined therapy, but suggest further studies.
journal_name
J Thromb Thrombolysisjournal_title
Journal of thrombosis and thrombolysisauthors
Di Pasquale P,Cannizzaro S,Parrinello G,Giambanco F,Vitale G,Fasullo S,Scalzo S,Ganci F,La Manna N,Sarullo F,La Rocca G,Paterna Sdoi
10.1007/s11239-006-5733-zsubject
Has Abstractpub_date
2006-04-01 00:00:00pages
147-57issue
2eissn
0929-5305issn
1573-742Xjournal_volume
21pub_type
杂志文章,随机对照试验abstract::Venous thromboembolism (VTE) is an important cause of morbidity and mortality in Western countries. The incidence rate of VTE is estimated at 1-2 cases per 1000 annually. This study was a population-based cohort study of previously treatment naïve patients with a first occurrence of venous thromboembolism (VTE), using...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/s11239-019-01966-y
更新日期:2019-11-01 00:00:00
abstract::Although clinical evidence supports a plausible association between thyroid disorders and venous thrombosis, reliable evidence is so far lacking on the potential biological mechanisms and neither temporary nor permanent thromboembolic risk factors were constantly identified. We performed a 2-years retrospective analys...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/s11239-008-0269-z
更新日期:2009-10-01 00:00:00
abstract::Persisting heparin-induced thrombocytopenia (HIT) is characterized by ongoing thrombocytopenia more than 7 days after stopping heparin. It is part of cases referred to as autoimmune HIT (aHIT). In contrast to typical HIT cases, aHIT involves heparin-independent platelet activation mechanism highlighted by a strongly p...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/s11239-020-02062-2
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abstract::We report a case of acquired thrombotic thrombocytopenic purpura (TTP) in a 34-year old patient with a prior diagnosis of systemic lupus erythematosis (SLE) who was recently started on hydroxychloroquine. Presenting symptoms included fevers, sore throat and productive cough with progressive weakness, dyspnea on exerti...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/s11239-010-0517-x
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abstract::While outpatient anticoagulation services (AMS) have existed extensively for a number of years, inpatient AMS have only recently begun to be implemented on a widespread basis. This is in direct response to anticoagulation regulations set forth by entities such as the Joint Commission (TJC) and the Centers for Medicare...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/s11239-011-0563-z
更新日期:2011-04-01 00:00:00
abstract::Each year venous thromboembolism (VTE) causes up to 60,000 deaths in the UK, many resulting from hospital-acquired thromboses following elective surgery. National Institute for Health and Clinical Excellence (NICE) guidelines state that all elective surgical patients should receive verbal and written information pre-o...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 临床试验,杂志文章
doi:10.1007/s11239-015-1224-4
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abstract::Edoxaban, alongside other direct oral anticoagulants (DOAC), is increasingly used for prevention of thromboembolism, including stroke. Despite DOAC therapy, however, annual stroke rate in patients with atrial fibrillation remains 1-2%. Rapid exclusion of relevant anticoagulation is necessary to guide thrombolysis or r...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/s11239-020-02143-2
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abstract::A main underlying pathology of coronary artery disease is the deposition of cholesterol in the arteries supplying blood to the heart that leads to stenosis and myocardial infarction. We tested if dyslipidemia is a risk factor for coronary artery disease in the Lebanese population, and studied the role of the total cho...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 临床试验,杂志文章,多中心研究
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journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/s11239-016-1462-0
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journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章,随机对照试验
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journal_title:Journal of thrombosis and thrombolysis
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doi:10.1007/s11239-021-02377-8
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journal_title:Journal of thrombosis and thrombolysis
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abstract::Hyperhomocysteinemia (HHcy) affects haemostasis and shifts its balance in favour of thrombosis. In vitro and in vivo studies suggested that HHcy may impair fibrinolysis either by influencing the plasma levels of fibrinolytic factors or by altering the fibrinogen structure. We investigated the influence of mild HHcy le...
journal_title:Journal of thrombosis and thrombolysis
pub_type: 临床试验,杂志文章
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journal_title:Journal of thrombosis and thrombolysis
pub_type: 临床试验,杂志文章
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journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/BF01060732
更新日期:1995-01-01 00:00:00
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journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
doi:10.1007/BF01064375
更新日期:1995-01-01 00:00:00
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journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章,随机对照试验
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更新日期:2014-10-01 00:00:00
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journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章,评审
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journal_title:Journal of thrombosis and thrombolysis
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journal_title:Journal of thrombosis and thrombolysis
pub_type: 临床试验,杂志文章,多中心研究
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journal_title:Journal of thrombosis and thrombolysis
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journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章
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journal_title:Journal of thrombosis and thrombolysis
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journal_title:Journal of thrombosis and thrombolysis
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journal_title:Journal of thrombosis and thrombolysis
pub_type: 杂志文章,评审
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journal_title:Journal of thrombosis and thrombolysis
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journal_title:Journal of thrombosis and thrombolysis
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