Clinical observation of tirofiban hydrochloride treating low-intermediate risk score patients with acute non-ST-segment elevation acute coronary syndrome

WANG Xi-fu; YE Ming; WANG Xin; LIU Hai-long; GUAN Xin-liang; LIU Fei; AI Hui

doi:10.3760/cma.j.issn.1673-4777.2013.07.002

Abstract：Objective To observe the clinical efficacy,including the occurrence of bleeding,acute ischemic events,changes of plasma fibrinogen and high sensitivity C-reactive protein(hs-CRP) of tirofiban hydrochloride among global registry of acute coronary events(GRACE) low-intermediate risk (＜ 140 scores) patients with acute non-ST-segment elevation acute coronary syndrome (NSTE-ACS).Methods All 412 hospitalized patients with NSTE-ACS were randomly divided into two groups:control group (n =198)and study group (n =214).Control group was administered with loading aspirin,clopidogrel oral and low molecular weight heparin subcutaneous injection.Study group was administered with tirofiban 0.4 μg/(kg · min) for the first 30 min,followed by aspirin,clopidogrel and low molecular weight heparin.Frequency of angina.The occurrence of bleeding and acute ischemic events were observed within 24 h.Blood inflammatory factors such as hs-CRP and fibrinogen(Fib) were determined after 24 h.Results Compared with control group,the frequency of angina and acute myocardial ischemia decreased significantly in study group [angina frequency:(1.9 ± 0.8) times/24 h vs (3.3 ± 0.9) times/24 h,morphine frequency:(0.8 ± 0.5) times/24 vs (1.6 ± 0.9) times/24 h,P ＜ 0.05].The patients of both groups showed neither huge amount of bleeding nor small amount of bleeding within 24 hours after the administration.There were 32 patients (15.0％) showing tiny amount of bleeding while it was improved after the dose of tirofiban.In control group,there were 13 patients (6.6％) having tiny amount of bleeding,which was significantly different from study group (P ＜0.05).Twenty-nine patients of control group underwent emergency percutaneous coronary intervention(PCI)with angina recurrent episodes and 10 patients of study group underwent emergency PCI; the difference was statistically significant(P ＜0.05).The levels of blood hs-CRP of pre-treatment and the end of 24 h of treatment were (6.3 ±0.7),(4.1 ± 0.4) mg/L respectively in the control group.The levels of blood hs-CRP of the study group were (6.4 ± 0.7) and (3.0 ± 0.4) mg/L; the levels of blood Fib of pre-treatment and the end of 24 h of treatment were (6.1 ± 0.7),(4.4 ± 0.5) g/L in the control group; and the levels of blood Fib of the study group were (6.0 ±0.6) and (3.2 ±0.5)g/L.The levels of hs-CRP and Fib at the end of 24 h of treatment were lower than those of pre-treatment in the control group and the study group(P ＜ 0.01).At the end of 24 h of treatment,the blood levels of hs-CRP and Fib in the study group were lower than those in the control group (P ＜ 0.05).Conclusions Tirofiban hydrochloride can effectively alleviate the clinical manifestations of GRACE score low-intermediate risk patients.It can reduce the level of inflammatory factors Fib and hs-CRP.