Optimal Platelet Inhibition for Primary Percutaneous Coronary Intervention

In STEMI patients, prasugrel plus a glycoprotein IIb/IIIa inhibitor produced the best physiologic results during the first 24 hours of treatment.

Adequate platelet inhibition is very important during percutaneous coronary intervention for ST-segment-elevation myocardial infarction. The relative effects of upstream inhibition of platelet activation (IPA) with oral clopidogrel or prasugrel and downstream inhibition of platelet aggregation with glycoprotein IIb/IIIa inhibition is unknown. In this industry-supported study, investigators in Italy compared oral prasugrel and intravenous tirofiban in 100 patients randomized 3:1:1:1 to four groups.

Prasugrel alone (60 mg)
Tirofiban (25 µg/kg bolus) and prasugrel
Tirofiban bolus and clopidogrel
Tirofiban bolus and infusion (0.15 µg/kg/min for 2 hours) with either prasugrel or clopidogrel (600 mg) at the end of the infusion

IPA was assessed by ligh…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI