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result sql = In vitro inhibition of platelet aggregation in response to increasing concentrations of tirofiban in patients with significant renal insufficiency.

In vitro inhibition of platelet aggregation in response to increasing concentrations of tirofiban in patients with significant renal insufficiency.

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char = n;code = 110
char = a;code = 97
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char = n;code = 110
char = s;code = 115
char = u;code = 117
char = f;code = 102
char = f;code = 102
char = i;code = 105
char = c;code = 99
char = i;code = 105
char = e;code = 101
char = n;code = 110
char = c;code = 99
char = y;code = 121
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char = <;code = 60
char = b;code = 98
char = r;code = 114
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char = >;code = 62
char = <;code = 60
char = b;code = 98
char = r;code = 114
char = /;code = 47
char = >;code = 62
char = <;code = 60
char = b;code = 98
char = >;code = 62
char = M;code = 77
char = E;code = 69
char = T;code = 84
char = H;code = 72
char = O;code = 79
char = D;code = 68
char = S;code = 83
char = ;code = 32
char = :;code = 58
char = ;code = 32
char = <;code = 60
char = /;code = 47
char = b;code = 98
char = >;code = 62
char = A;code = 65
char = ;code = 32
char = t;code = 116
char = o;code = 111
char = t;code = 116
char = a;code = 97
char = l;code = 108
char = ;code = 32
char = o;code = 111
char = f;code = 102
char = ;code = 32
char = 2;code = 50
char = 1;code = 49
char = ;code = 32
char = p;code = 112
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = e;code = 101
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char = t;code = 116
char = s;code = 115
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char = w;code = 119
char = e;code = 101
char = r;code = 114
char = e;code = 101
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char = d;code = 100
char = i;code = 105
char = v;code = 118
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char = d;code = 100
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = i;code = 105
char = n;code = 110
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char = o;code = 111
char = ;code = 32
char = t;code = 116
char = w;code = 119
char = o;code = 111
char = ;code = 32
char = g;code = 103
char = r;code = 114
char = o;code = 111
char = u;code = 117
char = p;code = 112
char = s;code = 115
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char = b;code = 98
char = a;code = 97
char = s;code = 115
char = e;code = 101
char = d;code = 100
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char = o;code = 111
char = n;code = 110
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char = e;code = 101
char = s;code = 115
char = t;code = 116
char = i;code = 105
char = m;code = 109
char = a;code = 97
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char = e;code = 101
char = d;code = 100
char = ;code = 32
char = c;code = 99
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char = e;code = 101
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = n;code = 110
char = i;code = 105
char = n;code = 110
char = e;code = 101
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char = c;code = 99
char = l;code = 108
char = e;code = 101
char = a;code = 97
char = r;code = 114
char = a;code = 97
char = n;code = 110
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char = e;code = 101
char = ;code = 32
char = (;code = 40
char = g;code = 103
char = r;code = 114
char = o;code = 111
char = u;code = 117
char = p;code = 112
char = ;code = 32
char = 1;code = 49
char = ;code = 32
char = <;code = 60
char = 4;code = 52
char = 6;code = 54
char = m;code = 109
char = l;code = 108
char = /;code = 47
char = m;code = 109
char = i;code = 105
char = n;code = 110
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char = ;code = 32
char = g;code = 103
char = r;code = 114
char = o;code = 111
char = u;code = 117
char = p;code = 112
char = ;code = 32
char = 2;code = 50
char = ;code = 32
char = >;code = 62
char = 4;code = 52
char = 6;code = 54
char = m;code = 109
char = l;code = 108
char = /;code = 47
char = m;code = 109
char = i;code = 105
char = n;code = 110
char = );code = 41
char = .;code = 46
char = ;code = 32
char = P;code = 80
char = l;code = 108
char = a;code = 97
char = t;code = 116
char = e;code = 101
char = l;code = 108
char = e;code = 101
char = t;code = 116
char = -;code = 45
char = r;code = 114
char = i;code = 105
char = c;code = 99
char = h;code = 104
char = ;code = 32
char = p;code = 112
char = l;code = 108
char = a;code = 97
char = s;code = 115
char = m;code = 109
char = a;code = 97
char = ;code = 32
char = f;code = 102
char = r;code = 114
char = o;code = 111
char = m;code = 109
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char = e;code = 101
char = a;code = 97
char = c;code = 99
char = h;code = 104
char = ;code = 32
char = s;code = 115
char = u;code = 117
char = b;code = 98
char = j;code = 106
char = e;code = 101
char = c;code = 99
char = t;code = 116
char = ;code = 32
char = w;code = 119
char = a;code = 97
char = s;code = 115
char = ;code = 32
char = t;code = 116
char = h;code = 104
char = e;code = 101
char = n;code = 110
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char = i;code = 105
char = n;code = 110
char = c;code = 99
char = u;code = 117
char = b;code = 98
char = a;code = 97
char = t;code = 116
char = e;code = 101
char = d;code = 100
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = ;code = 32
char = v;code = 118
char = i;code = 105
char = t;code = 116
char = r;code = 114
char = o;code = 111
char = ;code = 32
char = w;code = 119
char = i;code = 105
char = t;code = 116
char = h;code = 104
char = ;code = 32
char = i;code = 105
char = n;code = 110
char = c;code = 99
char = r;code = 114
char = e;code = 101
char = a;code = 97
char = s;code = 115
char = i;code = 105
char = n;code = 110
char = g;code = 103
char = ;code = 32
char = c;code = 99
char = o;code = 111
char = n;code = 110
char = c;code = 99
char = e;code = 101
char = n;code = 110
char = t;code = 116
char = r;code = 114
char = a;code = 97
char = t;code = 116
char = i;code = 105
char = o;code = 111
char = n;code = 110
char = s;code = 115
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char = o;code = 111
char = f;code = 102
char = ;code = 32
char = t;code = 116
char = i;code = 105
char = r;code = 114
char = o;code = 111
char = f;code = 102
char = i;code = 105
char = b;code = 98
char = a;code = 97
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char = 2;code = 50
char = 5;code = 53
char = ,;code = 44
char = ;code = 32
char = 3;code = 51
char = 7;code = 55
char = .;code = 46
char = 5;code = 53
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char = ;code = 32
char = a;code = 97
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char = d;code = 100
char = ;code = 32
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char = m;code = 109
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char = ,;code = 44
char = ;code = 32
char = a;code = 97
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char = d;code = 100
char = ;code = 32
char = l;code = 108
char = i;code = 105
char = g;code = 103
char = h;code = 104
char = t;code = 116
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char = t;code = 116
char = r;code = 114
char = a;code = 97
char = n;code = 110
char = s;code = 115
char = m;code = 109
char = i;code = 105
char = s;code = 115
char = s;code = 115
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char = o;code = 111
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char = a;code = 97
char = g;code = 103
char = g;code = 103
char = r;code = 114
char = e;code = 101
char = g;code = 103
char = o;code = 111
char = m;code = 109
char = e;code = 101
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char = r;code = 114
char = y;code = 121
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char = a;code = 97
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char = s;code = 115
char = a;code = 97
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char = w;code = 119
char = a;code = 97
char = s;code = 115
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char = u;code = 117
char = s;code = 115
char = e;code = 101
char = d;code = 100
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char = t;code = 116
char = o;code = 111
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char = a;code = 97
char = s;code = 115
char = s;code = 115
char = e;code = 101
char = s;code = 115
char = s;code = 115
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char = t;code = 116
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char = e;code = 101
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char = d;code = 100
char = e;code = 101
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char = e;code = 101
char = e;code = 101
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char = ;code = 32
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char = a;code = 97
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char = e;code = 101
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char = e;code = 101
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char = g;code = 103
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char = a;code = 97
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char = o;code = 111
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char = i;code = 105
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char = h;code = 104
char = a;code = 97
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char = (;code = 40
char = A;code = 65
char = D;code = 68
char = P;code = 80
char = );code = 41
char = .;code = 46
char = <;code = 60
char = b;code = 98
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char = >;code = 62
char = <;code = 60
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char = /;code = 47
char = >;code = 62
char = <;code = 60
char = b;code = 98
char = >;code = 62
char = R;code = 82
char = E;code = 69
char = S;code = 83
char = U;code = 85
char = L;code = 76
char = T;code = 84
char = S;code = 83
char = ;code = 32
char = :;code = 58
char = ;code = 32
char = <;code = 60
char = /;code = 47
char = b;code = 98
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char = P;code = 80
char = a;code = 97
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char = r;code = 114
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char = u;code = 117
char = p;code = 112
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char = 1;code = 49
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char = b;code = 98
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char = o;code = 111
char = f;code = 102
char = ;code = 32
char = 4;code = 52
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char = %;code = 37
char = ,;code = 44
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char = w;code = 119
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char = c;code = 99
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char = a;code = 97
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char = ;code = 32
char = a;code = 97
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char = 2;code = 50
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char = m;code = 109
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char = t;code = 116
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char = a;code = 97
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char = i;code = 105
char = o;code = 111
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char = o;code = 111
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char = ;code = 32
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char = r;code = 114
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char = i;code = 105
char = b;code = 98
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char = e;code = 101
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char = f;code = 102
char = e;code = 101
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char = a;code = 97
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char = a;code = 97
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char = p;code = 112
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char = a;code = 97
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char = e;code = 101
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char = e;code = 101
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char = i;code = 105
char = o;code = 111
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char = o;code = 111
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char = <;code = 60
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char = %;code = 37
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char = .;code = 46
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char = i;code = 105
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char = i;code = 105
char = b;code = 98
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char = o;code = 111
char = f;code = 102
char = ;code = 32
char = 1;code = 49
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char = %;code = 37
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char = w;code = 119
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char = f;code = 102
char = i;code = 105
char = b;code = 98
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char = .;code = 46
char = W;code = 87
char = e;code = 101
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char = f;code = 102
char = o;code = 111
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char = g;code = 103
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char = a;code = 97
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char = o;code = 111
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char = i;code = 105
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char = u;code = 117
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char = a;code = 97
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char = ,;code = 44
char = ;code = 32
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char = .;code = 46
char = 5;code = 53
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char = a;code = 97
char = n;code = 110
char = d;code = 100
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result sql = BACKGROUND : Patients with impaired renal function are a growing subset at higher risk for cardiovascular complications due to vasculopathic state, inducing accelerated atherosclerosis and arteriosclerosis. These patients are at increased risk for complications after coronary interventions, especially major bleeding events. As a result, this at-risk population of patients has not been well studied in most of the major clinical trials evaluating coronary interventions. Of particular interest is the optimal dosing of glycoprotein IIb-IIIa inhibitors in the setting of acute myocardial infarction. In this study, we attempted to find the in vitro concentration of tirofiban required to inhibit platelet aggregation to <10% in patients with moderate to severe renal insufficiency.

METHODS : A total of 21 patients were divided into two groups based on estimated creatinine clearance (group 1 <46ml/min; group 2 >46ml/min). Platelet-rich plasma from each subject was then incubated in vitro with increasing concentrations of tirofiban (25, 37.5, and 50ng/ml), and light transmission aggregometry assay was used to assess the degree of platelet aggregation in response to adenosine diphosphate (ADP).

RESULTS : Patients in group 1 had a baseline platelet aggregation of 45%, which decreased to 10% at a 25.0ng/ml concentration of tirofiban; the effect was enhanced to a platelet aggregation of <5% at higher doses. In contrast, subjects in group 2 with creatinine clearance >or=46ml/min had an average platelet aggregation inhibition of 12% with 50ng/ml of tirofiban.We found a significant decrease in platelet aggregation in group 2 at 25, 37.5, and 50ng/ml of tirofiban (p<0.05) in comparison with group 1.

CONCLUSIONS : Our data indicate that patients with moderate to severe renal dysfunction suppress their platelet aggregation to <10% with 25ng/ml of tirofiban, one-third of the standard effective dose for patients with normal renal function.We suggest further clinical trials to define an objective means to calculate proper renal dosing of glycoprotein IIb-IIIa inhibitors in these patients to prevent potentially fatal complication of major hemorrhagic events.

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