Inhibition of Platelet Aggregation With Eptifibatide, Bivalirudin, and Heparin in Patients Undergoing Percutaneous Coronary Intervention Receiving Clopidogrel Pretreatment (The PharmacoDynamic Evaluation of Angiomax, Clopidogrel With Or Without INtegrilin [DEACON] Study)

Bivalirudin and Clopidogrel With and Without Eptifibatide for Elective Stenting: Effects on Platelet Function, Thrombelastographic Indexes, and Their Relation to Periprocedural Infarction

“…These measurements may serve as cutpoints for GP IIb/IIIa administration in future PCI studies. Accordingly, the results of both the CLEAR PLATELETS and the CLEAR PLATELETS-2 studies may facilitate future investigations in patients undergoing elective stenting that are designed to optimize the use The marked platelet inhibition after eptifibatide treatment in the present study is consistent with the observations of Saucedo et al (13), the only prior pharmacodynamic investigation of bivalirudin therapy with and without eptifibatide in elective stenting. The Saucedo study differs from the CLEAR PLATELETS-2 study in the use of a 300-mg clopidogrel loading dose administered 15 to 30 min before PCI.…”

“…In another study, therapy with bivalirudin or UFH in addition to eptifibatide and clopidogrel resulted in the same degree of platelet inhibition. Moreover, no significant differences occurred in the platelet inhibition between the bivalirudin and UFH alone groups (13). Thus, the effect of bivalirudin with and without a GP IIb/IIIa inhibitor on platelet function in PCI patients is unclear.…”

“…Sample size and statistical analysis. A previous study using PPACK as the anticoagulant has shown that the addition of eptifibatide to bivalirudin and clopidogrel therapy produced ϳ80% inhibition of baseline aggregation in response to 5-M TRAP, whereas bivalirudin and clopidogrel therapy produced ϳ55% inhibition of baseline aggregation (13). We estimated that the eptifibatide plus bivalirudin would produce ϳ25% greater inhibition of baseline aggregation as compared with bivalirudin alone.…”

Antiplatelet and anticoagulant agents: key differences in mechanisms of action, clinical application, and therapeutic benefit in patients with non-ST-segment-elevation acute coronary syndromes

“…Platelet aggregation inhibition (PAI) in response to ADP was greater than 80% during eptifibatide infusion among patients who received eptifibatide and bivalirudin, and was significantly greater than that observed with either UFH or bivalirudin alone during the first 24 h [32]. PAI observed with UFH or bivalirudin alone was consistently less than 80% during the infusion period and was solely due to oral antiplatelet agents used in combination with the anticoagulants.…”

“…The open label, randomized Pharmacodynamic Evaluation of Angiomax, Clopidogrel, With or Without Integrilin (DEACON) study [32] compared the magnitude of inhibition of platelet aggregation using four regimens in 60 patients undergoing PCI who also received standard dose clopidogrel and aspirin:…”