Acute
peripheral arterial occlusive disease is an important factor affecting the mobility and mortality rate of elderly patients.
Catheter-guided arterial thrombolysis in these patients has its limitations: long lysis times, early occlusions, and high restenosis rates. The study investigated whether the use of
tirofiban has the same favorable effect as the
glycoprotein (
GP) IIb/IIIa receptor antagonist
abciximab and whether lysis times can be shortened and the disease course positively influenced by these substances. Sixty patients were randomly assigned to 2 groups. Each group received 5 mg recombinant tissue-type (rt-PA)
plasminogen activator by slow
intra-arterial injection for 10 minutes followed by 5 mg rt-PA per hour and 500 IU
heparin per hour IV. After randomization 1 group received a bolus of 0.25 mg
abciximab per kg
body weight followed by 10 mg per minute IV for 12 hours (
heparin was reduced to 250 IU/hr). The other group received a bolus of 0.4 microg
tirofiban per kg
body weight as well as postinterventional medication with 0.1 microg
tirofiban per minute and kg
body weight for 24 hours. During medication with
GP IIb/IIIa inhibitor, the patients received a reduced
heparin dosage for 24 hours. After 24 hours both groups received 200 mg
aspirin orally and full heparinization controlled on the basis of the partial thromboplastin time. The following efficacy criteria were analyzed:
rehospitalization events, reintervention events, and
amputations within 6 months. Secondary endpoints were changes in the Fontaine stage, the crurobrachial index, the distance to claudication, and the duration of local arterial lysis. No significant differences were found between the
abciximab and
tirofiban groups in terms of the
rehospitalization, reintervention, or
amputation rates, nor were there any group differences in the total number of events. The secondary parameters, such as the crurobrachial index, distance to claudication, and Fontaine stage, also showed no significant differences between the 2 groups within 6 months. The duration of lysis was significantly shorter in the
abciximab group. Major
bleeding events did not occur in either group. With regard to the adverse effect rate, there were no significant differences between the 2 groups. Both
abciximab and
tirofiban can be used successfully in patients with
peripheral arterial occlusive disease and arterial
thrombosis.