caa a22 4500 475823737 CHVBK 20180406123825.0 cr unu---uuuuu 170329e20000101xx s 000 0 eng 10.1023/A:1018650123272 doi (NATIONALLICENCE)springer-10.1023/A:1018650123272 Inhibition of Platelet Aggregation with a Glycoprotein IIb-IIIa Antagonist Does Not Prevent Thrombin Generation in Patients Undergoing Thrombolysis for Acute Myocardial Infarction [Elektronische Daten] [Neal Kleiman, Russell Tracy, J. Talley, Kristina Sigmon, Diane Joseph, Eric Topol, Robert Califf, Michael Kitt, E. Ohman] Thrombin activity has been implicated as a mechanism for failed reperfusion and reocclusion following thrombolysis. Aggregating platelets provide a phospholipid surface on which prothrombin is cleaved to form thrombin. We examined markers of thrombin generation and activity in patients enrolled in a randomized, placebo-controlled, dose escalating trial of the platelet glycoprotein IIb-IIIa inhibitor eptifibatide (Integrilin™) administered concomitantly with tissue plasminogen activator for the treatment of myocardial infarction. Measurements were obtained at baseline, at 90 minutes, and at 6, 12, and 24 hours after starting therapy. Eptifibatide inhibited platelet aggregation in response to 20 µM ADP. Levels of fibrinopeptide A (FPA), thrombin-antithrombin complexes (TAT), and prothrombin fragment 1.2 (F1.2) were not lower in patients treated with eptifibatide than in the control group. In the course of dose escalation, two groups of patients received the same 135 µg/kg bolus of eptifibatide, one with and one without a heparin bolus. FPA levels were dramatically lower in the heparin-treated patients. Levels of FPA, TAT, and F1.2 were not higher in patients with than in those without recurrent ischemia, or in patients without than in those with Thrombolysis in Myocardial Infarction (TIMI) grade 3 angiographic flow at 90 minutes. These data suggest that thrombin generation and activity persist following thrombolysis, despite inhibition of platelet aggregation, and that treatment with inhibitors of thrombin activity may be required even when glycoprotein IIb-IIIa inhibitors are used. Kluwer Academic Publishers, 2000 eptifibatide nationallicence thrombolysis nationallicence glycoprotein IIb-IIIa nationallicence myocardial infarction nationallicence Kleiman Neal Baylor College of Medicine and the Methodist Hospital, Houston, Texas aut Tracy Russell Department of Medicine, Section of Cardiology, Baylor College of Medicine and The Methodist Hospital, Houston, Texas aut Talley J. Department of Medicine, University of Arkansas, Little Rock, Arkansas aut Sigmon Kristina Duke Clinical Research Institute, Durham, North Carolina aut Joseph Diane Duke Clinical Research Institute, Durham, North Carolina aut Topol Eric Cleveland Clinic Foundation, Cleveland, Ohio aut Califf Robert Duke Clinical Research Institute, Durham, North Carolina aut Kitt Michael COR Therapeutics, South San Francisco, California, USA aut Ohman E. Duke Clinical Research Institute, Durham, North Carolina aut Journal of Thrombosis and Thrombolysis Kluwer Academic Publishers 9/1(2000-01-01), 5-12 0929-5305 9:1<5 2000 9 11239 https://doi.org/10.1023/A:1018650123272 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1023/A:1018650123272 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Kleiman Neal Baylor College of Medicine and the Methodist Hospital, Houston, Texas aut NATIONALLICENCE 700 1- Tracy Russell Department of Medicine, Section of Cardiology, Baylor College of Medicine and The Methodist Hospital, Houston, Texas aut NATIONALLICENCE 700 1- Talley J. Department of Medicine, University of Arkansas, Little Rock, Arkansas aut NATIONALLICENCE 700 1- Sigmon Kristina Duke Clinical Research Institute, Durham, North Carolina aut NATIONALLICENCE 700 1- Joseph Diane Duke Clinical Research Institute, Durham, North Carolina aut NATIONALLICENCE 700 1- Topol Eric Cleveland Clinic Foundation, Cleveland, Ohio aut NATIONALLICENCE 700 1- Califf Robert Duke Clinical Research Institute, Durham, North Carolina aut NATIONALLICENCE 700 1- Kitt Michael COR Therapeutics, South San Francisco, California, USA aut NATIONALLICENCE 700 1- Ohman E. Duke Clinical Research Institute, Durham, North Carolina aut NATIONALLICENCE 773 0- Journal of Thrombosis and Thrombolysis Kluwer Academic Publishers 9/1(2000-01-01), 5-12 0929-5305 9:1<5 2000 9 11239 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer