Platelet aggregation inhibition by Eptifibatide versus high dose Tirofiban during primary percutaneous interventions

Comparison of the effect of ticagrelor combined with tirofiban versus clopidogrel combined with tirofiban on inflammation response and prognosis of patients with unstable angina pectoris in long term follow-up

To investigate the effect of ticagrelor combined with tirofiban versus clopidogrel combined with tirofiban on inflammation response and prognosis of patients with unstable angina pectoris (UA). The present prospective study included a total of 291 patients who were diagnosed as unstable UA from January 2018 to December 2019. All UA patients were divided into two groups: ticagrelor combined with tirofiban group (n = 159) and clopidogrel combined with tirofiban group (n = 132). Serum levels of C-reactive protein (CRP), interleukin-1β, interleukin-6, tumor necrosis factor-α, and matrix metalloproteinase-9 were measured using commercially available enzyme-linked immunosorbent assay kits. Kaplan-Meier (K-M) curve was performed for analysis of cumulative incidences of major adverse cardiovascular events (MACEs). Both ticagrelor combined with tirofiban and clopidogrel combined with tirofiban significantly decreased the serum levels of inflammatory factors in UA patients. Compared to clopidogrel combined with the tirofiban group, ticagrelor combined with the tirofiban group had a lower platelet aggregation rate and improved cardiac function of UA patients. Besides, ticagrelor combined with tirofiban group had a better prognosis and the K-M curve showed that UA patients treated by ticagrelor and tirofiban had lower incidences of MACEs in one-year follow-up. The treatment of ticagrelor combined with tirofiban significantly attenuated inflammation response and improved the prognosis of UA patients.

Surface modification of polyurethane with eptifibatide-loaded degradable nanoparticles reducing risk of blood coagulation

The main purpose of the work was to develop a drug releasing coatings on the surface of medical devices exposed to blood flow, what should enable effective inhibition of blood coagulation process. As a part of the work, the process of encapsulating the anticoagulant drug eptifibatide (EPT) in poly(DL-lactic-co-glycolic acid) (PLGA) nanoparticles was developed. EPT encapsulation efficiency was 29.1 ± 2.1%, while the EPT loading percentage in the nanoparticles was 4.2 ± 0.3%. The PLGA nanoparticles were suspended in a polyanion solution (hyaluronic acid (HA)) and deposited on the surface-treated thermoplastic polyurethane (TPU) by a layer-by-layer method. As a polycation poly-L-lysine (PLL) was used. The influence of released EPT on the activation of the coagulation system was analyzed using dynamic blood tester. Performed experiments show an effective delivery of the drug to the bloodstream and low risk of platelets (membrane receptor) activation. The dynamic blood test process, including its physical phenomenon, was described using numerical methods, i.e. a finite volume cone-and-plate test model as well as non-Newtonian blood models. The values of shear stress and blood flow velocity under the fast-rotating cone were computed applying boundary conditions of cylinder wall imitating blood-nanomaterial interaction. Implementing boundary conditions as initial shear stress values of bottom cylinder wall resulted in the increase of shear stress in blood under rotating cone. The developed system combining drug eluting polymeric nanoparticles with the polyelectrolyte "layer-by-layer" coating can be easily introduced to medical implants of various shape, with the advantages of resorbable drug carriers allowing for local and controllable delivery of anti-thrombogenic drugs.

Efficacy and safety of eptifibatide versus tirofiban in acute coronary syndrome patients: A systematic review and meta-analysis

BACKGROUND

Glycoprotein IIb/IIIa inhibitors were the strongest available antiplatelet therapy and have been shown to reduce cardiac ischemic complications in patients undergoing percutaneous coronary intervention. However, evidences are still lacking on the superiority of eptifibatide over tirofiban or vice versa in patients with acute coronary syndrome.

OBJECTIVE

To compare the efficacy and safety of eptifibatide and tirofiban used among patients with acute coronary syndrome by performing a systematic review and meta-analysis of randomized controlled trials.

METHODS

A systematic search was conducted in Pubmed, Ovid/Medline, Ovid/Embase, Clinicaltrials.gov, CBM and CNKI to identify randomized controlled trials comparing eptifibatide with tirofiban for acute coronary syndrome until November 2015. The methodological quality was assessed with the Cochrane bias risk assessment tool.

RESULTS

1256 patients from 9 randomized controlled trials were finally included. Compared with tirofiban, eptifibatide could reduce more risk of thrombolysis in myocardial infarction minor bleeding (RR 0.61, 95%CI 0.38, 0.98). However, no significant differences were observed for major adverse cardiac events (RR 0.41, 95%CI 0.15 to 1.12), major bleeding, thrombocytopenia in the two treatment groups. The relative treatment benefits were similar in subgroups of patients according to types of acute coronary syndrome, or undergoing percutaneous coronary intervention.

CONCLUSION

Available evidence suggests that the safety of eptifibatide is slightly superior to tirofiban in patients with acute coronary syndrome, but no significant difference was observed on efficacy. Future studies should focus on the randomized controlled trials with larger sample, multi-center, long-term follow-up, high quality to compare the two drugs.