The Effect Of Tirofiban In The Thrombolytic Therapy Of The Patients With Acute Myocardial Infarction

Objective:To observe the safety and efficacy of platelet glycoproteinⅡb/Ⅲa receptors antagonist (tirofiban) in the thrombolytic therapy of the patients with acute ST-elevation myocardial infarction.Methods:108 cases with acute ST-elevation myocardial infarction from January 2008 to February 2011 were observed. They were 75 male patients and 33 female patients and their age ranged from 31 to 76years, with the mean age of 54±10 years. They were divided into two groups which one was conventional thrombolytic therapy group(52 patients) and the other was intensive thrombolytic therapy group(56 patients) according to they agreed to accept Tirofiban self-paying or not. Before they acceped the thrombolytic therapy, the patients were divided into extreme low risk group, low risk group, middling risk group, high risk group and extreme high risk group according to the CRUSADE bleeding risk scords. The conventional thrombolytic therapy group accepted urokinase(2.2wu/kg,in 30min) via vein and aspirin(300mg,chawing) and clopidogrel(300mg,chawing)and following aspirin(300mg, 1/d), clopidogrel (75mg,1/d), low molecular weight heparin calium(5000iu, 1/12h, subcutaneous injection,5-7d), nitrates, beta-blockers, ACEI or ARB and statins drugs. The intensive thrombolytic therapy group accepted the same treatment as the conventional thrombolytic therapy group and the tirofiban was given according to the CRUSADE bleeding risk estimating. The grouping conditions, relief of chest pain in 1-2 hours, falling of ST on electrocardiogram in 90 minutes, reperfusion arrhythmia in 2 hours and bleeding complications were observed.Results:②Grouping conditions:There was no significant difference(P>0.05) in the two groups about attract age, attract time and the bleeding risk.②The relief of chest pain in 1-2 hours:There were 50 patients that the chest pain relieved distinctly in 2 hours in the intensive thrombolytic therapy group and 33 patients in the conventional thrombolytic therapy group, the raotio was 98%vs 66%. Analyzing the efficacy statistically of the two groups, there was significant difference(P<0.05).③Falling of ST on electrocardiogram in 90 minutes:There were 54 patients that the falling of ST which rose most obviously on electrocardiogram was equal or greater than 50% and 29 patients in the conventional thrombolytic therapy group, the raotio was 96% vs 56%. Analyzing the efficacy statistically of the two groups, there was significant difference(P<0.05).④Reperfusion arrhythmia in 2 hours:There were 42 patients who had reperfusion arrhythmia after accepting thrombolytic therapy 2 hours in the intensive thrombolytic therapy group and 22 patients in the conventional thrombolytic therapy group, the raotio was 76%vs 42%. Analyzing the efficacy statistically of the two groups, there was significant difference(P<0.05).⑤Bleeding complications:There were 8 patients that had a bit haemorrhage in the intensive thrombolytic therapy group and 5 patients in the conventional thrombolytic therapy group. The two groups had no hemorrhoea and the raotio of bit haemorrhage was 14%vs 10%. Analyzing the efficacy statistically of the two groups, there was no significant difference(P>0.05).⑥The variation of blood coagulation function: There were 2 patients that platelet had a mild decrease in the intensive thrombolytic therapy group and nobody in the conventional thrombolytic therapy group. The P,APTT,FB,INR had no obvious changes in two groups after thrombolytic therapy.Conclusion:The intensive thrombolytic therapy can markedly improve the revascularization rate of the infarction relation artery and did not increased the obverious haemorrhage complication, safe and effective, so it could be a recommendation for thrombolytic therapy of the patients with acute myocardial infarction.