Use of Abciximab and Tirofiban in Patients with Peripheral Arterial Occlusive Disease and Arterial Thrombosis

Abstract

Acute peripheral arterial occlusive disease is an important factor affecting the mobility and mortality rate of elderly patients. Catheter-guided arterial thrombolysis in these patients has its limitations: long lysis times, early occlusions, and high restenosis rates. The study investigated whether the use of tirofiban has the same favorable effect as the glycoprotein (GP) IIb/IIIa receptor antagonist abciximab and whether lysis times can be shortened and the disease course positively influenced by these substances. Sixty patients were randomly assigned to 2 groups. Each group received 5 mg recombinant tissue-type (rt-PA) plasminogen activator by slow intra-arterial injection for 10 minutes followed by 5 mg rt-PA per hour and 500 IU heparin per hour IV. After randomization 1 group received a bolus of 0.25 mg abciximab per kg body weight followed by 10 mg per minute IV for 12 hours (heparin was reduced to 250 IU/hr). The other group received a bolus of 0.4 microg tirofiban per kg body weight as well as postinterventional medication with 0.1 microg tirofiban per minute and kg body weight for 24 hours. During medication with GP IIb/IIIa inhibitor, the patients received a reduced heparin dosage for 24 hours. After 24 hours both groups received 200 mg aspirin orally and full heparinization controlled on the basis of the partial thromboplastin time. The following efficacy criteria were analyzed: rehospitalization events, reintervention events, and amputations within 6 months. Secondary endpoints were changes in the Fontaine stage, the crurobrachial index, the distance to claudication, and the duration of local arterial lysis. No significant differences were found between the abciximab and tirofiban groups in terms of the rehospitalization, reintervention, or amputation rates, nor were there any group differences in the total number of events. The secondary parameters, such as the crurobrachial index, distance to claudication, and Fontaine stage, also showed no significant differences between the 2 groups within 6 months. The duration of lysis was significantly shorter in the abciximab group. Major bleeding events did not occur in either group. With regard to the adverse effect rate, there were no significant differences between the 2 groups. Both abciximab and tirofiban can be used successfully in patients with peripheral arterial occlusive disease and arterial thrombosis.

Popliteal artery thrombosis following total knee arthroplasty managed successfully with percutaneous intervention

“…These agents have been used in peripheral arterial occlusive disease and arterial thrombosis as well 10 11. When used as an adjunct to thrombolysis for peripheral artery thrombosis, some studies have shown that these agents may reduce distal thromboembolism without an increase in haemorrhagic complications 12.…”

Review of Currently Available GP IIb/IIIa Inhibitors and Their Role in Peripheral Vascular Interventions

“…No significant differences were found in patency rates, outcomes, or complications. 26 The economic implications of the addition of GP IIb/IIIa inhibitors to peripheral arterial lysis were examined in the PROMPT (Platelet Receptor Antibodies in Order to Manage Peripheral Artery Thrombosis) Trial population. Seventy patients receiving urokinase thrombolytic infusions for peripheral arterial occlusions were randomized to receive either abciximab or placebo.…”

Peripheral arterial disease, acute coronary syndromes, and early invasive management: The TACTICS TIMI 18 trial

“…Limited prior data suggest that therapy with the platelet glycoprotein (GP) IIb/IIIa receptor inhibitor tirofiban is effective and well tolerated by patients with PAD undergoing peripheral arterial angiography and revascularization. 7 However, it remains unclear whether patients with NSTE ACS and PAD treated with GP IIb/IIIa receptor antagonists and inva-sive management strategies would have favorable outcomes. Therefore, we undertook the present analysis from the Treat angina with Aggrastat and determine Cost of Therapy with an Invasive or Conservative Strategy (TACTICS) Thrombolysis in Myocardial Infarction (TIMI) 18 trial, 8 to assess the benefits and tolerability of GP IIb/IIIa receptor antagonism together with early invasive management among patients with PAD and NSTE ACS.…”