Pharmaceutical Interventions for the Management of No-Reflow

Tim A. Fischell, MD

J Invasive Cardiol. 2008;20(7):374-379. 

In This Article

Glycoprotein IIb/IIIa Inhibitors

Interference with platelet aggregation through glycoprotein (GP) IIb/IIIa receptor inhibition is a theoretically attractive method for management of no-reflow that awaits confirmation by randomized study. Tirofiban reduced no-reflow in a canine non-thrombotic coronary occlusion model, and was more effective than aspirin or clopidogrel in attenuating no-reflow in a swine infarction/reperfusion model, but reports in human subjects are scant and inconclusive.[37,38,39]

Clinical reports suggest that abciximab improves epicardial flow and microvascular perfusion as an adjunct to reduced-dose thrombolysis[40] and after primary PCI.[41] In a subset of 101 patients with SVGs undergoing high-risk PCI, adjunctive abciximab bolus and infusion were associated with an 87% reduction in distal embolization compared with placebo (2% vs. 18%, p = 0.017), with a trend toward reduction in early large non-Q-wave AMI (2% vs .12%, p = 0.165).[42]


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