The Effect And Safety Evaluation Of Tirofiban On Non-ST-Segment Elevation Myocardial Infarction Befor Early Invasive Treatment

Objective: To discuss the efficacy and safety of tirofiban based the conventional therapy:aspirin, clopidogrel, low molecular weight heparin (LMWH) when treat low-risk and moderate-risk patients with non-ST-segment elevation myocardial infarction (NSTEMI).Method:Selected 57 hospitalized patients with NSTEMI from March 2010 to April 2011, All patients were randomly divided into two groups:the tirofiban group(n=28) and the control group(n=26). All patients received coronary artery imaging within 5-7days.All 57 selected patients administered aspirin 300mg and clopidogrel 300mg at initial dose, then aspirin 100mg and clopidogrel 75mg everyday. On this base, injected intravenously tirofiban in tirofiban group, the loading dose was 0.4ug.kg-1min-1by intravenous drip in 30 minutes, then maintenance dose was given 48hours of 0.1μg.kg-1min-1; at the same injected hypodermicly LMWH (enoxapain: 40mg/12h), then used continuously 3-5 days after stoping tirofiban (enoxapain: 1mg/10kg/12h). While only LMWH was given in control group 5-7days (enoxapain:1mg/kg/12h).Result: The rate to achieve TIMI3 blood flow of the IRA in tirofiban group was higer than that in control group(78.2%vs50%, P<0.05). There was no statistical difference in EF and LVEDD before and after coronary artery imaging between two groups (P>0.05). It was showed that there was difference in myocardial infarction again,angina pectoris in tirofiban group and control group (P<0.05), but no difference in Death, malignant arrhythmia,target pathological changes revasculariztion therapy, cardiac insufficiency worsen(cardiac functional grading raise above 1 grade) (P>0.05). Though APTT value increased in tirofiban group after being given tirofiban for 24h and 48h (P<0.05), still not excceded its two times value of normal;and there was no significant change after being given tirofiban for 72h (P>0.05).The rate of nonsignificant hemorrage and mild thrombocytopenia in tirofiban group was higher than that in control group.Conclusion:Tirofiban based the conventional therapy:aspirin, clopidogrel, LMWH when treat patients with non-ST-segment elevation myocardial infarction (NSTEMI) is safe when treat patients with NSTEMI under the condition of detecting platelet count strictly and continuously. There is difference between observation group and control group for decreasing incidence in angina pectoris, malignant arrhythmia in tirofiban group and control group,but no difference in Death, myocardial infarction again,target pathological changes revasculariztion therapy, cardiac insufficiency worsen(cardiac functional grading raise above 1 grade) in hospital and 30day post-discharge.