Effectiveness and Safety of Domestic Tirofiban for Chinese Population with Non-ST-elevation Acute Coronary Syndrome: A Meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

 LIUJian-feng ¹ ^# ,  ZHUYing ² ^# , WANGXiao-wei ³ ,  LIULi-hong ²

1. Department of Inpatient, Beijing Likang Hospital, Beijing 102609, China;
2. Department of Pharmacy, Beijing Chaoyang Hospital, Beijing 100020, China;
3. Beijing Institute of Neurosurgery, Capital Medical University, Beijing 100026, China;

Corresponding?author：

LIULi-hong, Email: hongllh@126.com

Keywords：

Tirofiban; Acute coronary syndrome; Non-ST-elevation acute coronary syndrome; Non-ST-elevation acute myocardial infarction; Systematic review; Meta-analysis; Randomized controlled trial

DOI：

10.7507/1672-2531.20150016

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To systematically review the effectiveness and safety of domestic tirofiban for Chinese population with non ST-elevation acute coronary syndromes (NSTE-ACS) in non-interventional therapy. Methods We searched databases including The Cochrane Library (Issue 11, 2013), PubMed, EMbase, CBM, CNKI, VIP and WanFang Data from 1994 to 2014 to collect randomized controlled trials (RCTs) about domestic tirofiban for NSTE-ACS patients in non-interventional therapy. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality of included studies. Meta-analysis was then conducted using RevMan 5.2 software. Results A total of 23 RCTs were enrolled involving 2 425 patients. The results of meta-analysis showed that:a) the effectiveness of tirofiban in the trial group was significantly better than that in the control group (OR=3.62, 95%CI 2.33 to 5.63, P<0.000 01); b) ST segment down improvement in the trial group was better than that in the control group (WMD=0.39, 95%CI 0.30 to 0.49, P<0.000 01); c) improvement of platelet aggregation in the trial group was better than that in the control group (WMD=27.89, 95%CI 25.45 to 30.34, P<0.000 01); d) the incidences of cardiovascular events of composite endpoints in the trial group were lower than that in the control group (during 36 h:OR=0.20, 95%CI 0.12 to 0.31, P<0.000 01; and after 30 days:OR=0.31, 95%CI 0.23 to 0.42, P<0.000 01); and e) the incidence rate of bleeding in the trial group was higher than that in the control group (OR=1.53, 95%CI 1.09 to 2.15, P=0.02). Conclusion Compared with routine drugs used alone, tirofiban has better therapeutic effects in non-interventional therapy for Chinese population with NSTE-ACS, but the incidence of bleeding is relatively high.

Citation： LIUJian-feng, ZHUYing, WANGXiao-wei, LIULi-hong. Effectiveness and Safety of Domestic Tirofiban for Chinese Population with Non-ST-elevation Acute Coronary Syndrome: A Meta-analysis. Chinese Journal of Evidence-Based Medicine, 2015, 15(1): 90-98. doi: 10.7507/1672-2531.20150016 Copy

1.	Greco ED, Ramsdale DR. Acute coronary syndrome:unstable angina and non-ST-segment elevation myocardial infarction. BMJ, 2003, 326(7401):1259-1261.
2.	Hamm CW, Bassand JP, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Euro Heart J, 2011, 32(23):2999-3054.
3.	Song Y. Evaluation on the safety and efficacy of tirofiban in the treatment of acute coronary syndrome. J Huazhong Univ SciTechnolog Med Sci, 2007, 27(2):142-144.
4.	Rasoul S, Ottervanger JP, de Boer MJ, et al. Routine upstream versus selective down stream use of tirofiban in non-ST elevation myocardial infarction patients scheduled for early invasive therapy; a randomized comparison. J Thromb Thrombolysis, 2007, 24(3):241-246.
5.	國際心臟病學會和協會及世界衛生組織命名標準化聯合專題組. 缺血性心臟病的命名及診斷標準.中華心血管病雜志, 1981, 9(1):75-76.
6.	Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0).[cited 2012 Jan 5]. Available at:http://www.cochrane-handbook.org.
7.	李皓亮. 替羅非班治療急性非ST段抬高心肌梗死的臨床觀察. 中國現代藥物應用, 2008, 2(24):67-68.
8.	劉華東. 替羅非班在藥物治療非ST段抬高型心肌梗死中的療效及安全性觀察. 山東醫藥, 2008, 48(27):94-95.
9.	張璟軼, 熊世熙, 龔雯. 替羅非班治療非ST段抬高急性冠狀動脈綜合征的臨床觀察. 醫學新知雜志, 2008,18(5):276-277, 279.
10.	黃紅梅, 李俐. 替羅非班治療老年非ST段抬高急性冠脈綜合征的臨床研究. 中國循證心血管醫學雜志, 2011, 3(1):41-43.
11.	李章偉, 韓笑, 鄭琳. 替羅非班治療非ST段抬高型急性冠脈綜合征的臨床觀察. 中國初級衛生保健, 2011, 25(9):84-85.
12.	趙偉, 龐志華. 非ST段抬高型急性冠狀動脈綜合征患者應用國產替羅非班的療效觀察.實用臨床醫藥雜志, 2012, 16(1):42-44.
13.	張健, 石宇杰, 崔俊玉, 等. 鹽酸替羅非班治療非ST段抬高急性冠脈綜合征的臨床療效.中國循證心血管醫學雜志, 2012, 4(1):18-19.
14.	邱惠, 張宇晨, 王雷, 等. 替羅非班對非ST段抬高急性冠脈綜合征的治療作用. 北京醫學, 2009, 31(2):65-67.
15.	高艷霞, 李凌, 劉懷霖, 等. 替羅非班治療非ST段抬高型急性心肌梗死臨床觀察. 鄭州大學學報(醫學版), 2009, 44(2):406-408.
16.	李昌, 林琍, 宗文霞. 替羅非班治療不穩定型心絞痛和非ST段抬高心肌梗死49例. 中國藥業, 2009, 18(7):41-42.
17.	丁智曉, 任建民, 劉曉梅. 替羅非班治療非ST段抬高急性冠脈綜合征的臨床觀察. 重慶醫學, 2009, 38(12):1487-1488.
18.	王建玲, 王敬萍, 王日軍. 替羅非班治療非ST段抬高型急性冠狀動脈綜合征的臨床觀察. 中國藥物與臨床, 2010, 10(1):77-78.
19.	楊昌林, 劉呂紅.國產替羅非班治療老年急性非ST段抬高型心肌梗死臨床觀察.現代中西醫結合雜志, 2010, 19(10):1192-1193.
20.	朱玲軍, 林文輝, 張凌志.替羅非班治療急性非ST抬高型心肌梗死的療效和安全性評價. 海峽藥學, 2011, 23(8):115-117.
21.	許勇. 鹽酸替羅非班治療非ST段抬高急性冠狀動脈綜合征40例臨床療效觀察. 中國醫藥指南, 2012, 10(22):41-42.
22.	盧云飛. 替羅非班治療非ST段抬高型急性冠脈綜合征78例的臨床研究. 貴陽中醫學院學報, 2012, 34(5):82-85.
23.	王曉陽. 小劑量替羅非班治療高齡非ST段抬高急性冠狀動脈綜合征患者的療效及安全性.中國醫藥指南, 2012, 10(33):429-430.
24.	楊遇春, 吳明祥, 張治平, 等. 新型國產替羅非班在非介入治療的急性非ST段抬高型心肌梗死患者的療效與安全性觀察. 中國美容醫學, 2012, 21(10):252-253.
25.	陳靜波. 鹽酸替羅非班治療非ST段抬高急性冠脈綜合征的療效與安全性. 中國醫學工程, 2013, 21(2):174-175.
26.	林高平. 替羅非班對非ST段抬高性急性冠脈綜合征的療效觀察. 中外醫學研究, 2013, 11(6):25-26.
27.	李杰. 替羅非班治療老年非ST段抬高急性冠脈綜合征的臨床療效觀察. 中國臨床研究, 2013, 26(4):334-335.
28.	梁莉. 替羅非班治療老年非ST段抬高急性冠脈綜合征的療效觀察. 臨床軍醫雜志, 2013, 41(4):338-339, 346.
29.	吉小利, 陳桂芬, 訾娟. 替羅非班對急性非ST段抬高心肌梗死患者近期臨床預后的影響. 山東醫藥, 2011, 51(13):81-82.
30.	徐成斌. ACS的病理與病理生理學. 中國原刊, 2001, 36(11):6-7.
31.	PRISM Study Investigators. A comparision of aspirin plus tirofiban with aspirin plus heparin for unstable angina. Platelet receptor inhibition in ischemic syndrome management. N Engl J Med, 1998, 338(21):1498-1505.
32.	PRISM-PLUS Study Investigators. Platelet receptor inhibition in ischemic syndrome management in patients limited by unstable signs and symptoms. N Engl J Med, 1998, 338(21):1488-1497.
33.	王兆鉞. 抗血小板藥的臨床應用. 中華內科雜志, 2007, 46(11):958-959.
34.	申華, 周玉杰. 2011歐洲心臟病學會非ST段抬高型急性冠脈綜合征處理指南更新解讀.中國醫學前沿雜志(電子版), 2011, 3(5):97-99.
35.	廖業敏, 程芝俏. 氯吡格雷、阿司匹林和低分子肝素聯用對急性非ST段抬高心肌梗死的療效分析.中國心血管病研究雜志, 2007, 5(1):33-35.
36.	趙新華. 氯吡格雷與拜阿司匹林和低分子肝素鈣治療非ST段抬高型心肌梗死36例臨床觀察. 臨床醫藥實踐. 2010, 19(12):961-962.
37.	中華心血管病雜志編輯委員會. 2013抗血小板治療中國專家共識. 2013, 41(3):183-194.
38.	Cannon CP. Small molecule glycoprotein Ⅱb/Ⅲa receptor inhibitors as upstream therapy in acute coronary syndromes:insights from the TACTICS TIMI-18 trial. J Am Coll Cardiol, 2003, 41(4):43-48.
39.	Steinhub SR, Moliterno DJ. Glycoprotein IIb/IIIa receptor and tag on it for the treatment of unstable angina. Heart Vessels, 1997, (Supp l 12):148-155.
40.	董蔚, 陳韻岱, 錢庚, 等. 國產替羅非班在急性冠狀動脈綜合征應用注冊研究. 中華內科雜志, 2013, 52(10):815-818.

1. Greco ED, Ramsdale DR. Acute coronary syndrome:unstable angina and non-ST-segment elevation myocardial infarction. BMJ, 2003, 326(7401):1259-1261.
2. Hamm CW, Bassand JP, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Euro Heart J, 2011, 32(23):2999-3054.
3. Song Y. Evaluation on the safety and efficacy of tirofiban in the treatment of acute coronary syndrome. J Huazhong Univ SciTechnolog Med Sci, 2007, 27(2):142-144.
4. Rasoul S, Ottervanger JP, de Boer MJ, et al. Routine upstream versus selective down stream use of tirofiban in non-ST elevation myocardial infarction patients scheduled for early invasive therapy; a randomized comparison. J Thromb Thrombolysis, 2007, 24(3):241-246.
5. 國際心臟病學會和協會及世界衛生組織命名標準化聯合專題組. 缺血性心臟病的命名及診斷標準.中華心血管病雜志, 1981, 9(1):75-76.
6. Higgins JP, Green S. Cochrane Handbook for Systematic Reviews of Interventions (Version 5.1.0).[cited 2012 Jan 5]. Available at:http://www.cochrane-handbook.org.
7. 李皓亮. 替羅非班治療急性非ST段抬高心肌梗死的臨床觀察. 中國現代藥物應用, 2008, 2(24):67-68.
8. 劉華東. 替羅非班在藥物治療非ST段抬高型心肌梗死中的療效及安全性觀察. 山東醫藥, 2008, 48(27):94-95.
9. 張璟軼, 熊世熙, 龔雯. 替羅非班治療非ST段抬高急性冠狀動脈綜合征的臨床觀察. 醫學新知雜志, 2008,18(5):276-277, 279.
10. 黃紅梅, 李俐. 替羅非班治療老年非ST段抬高急性冠脈綜合征的臨床研究. 中國循證心血管醫學雜志, 2011, 3(1):41-43.
11. 李章偉, 韓笑, 鄭琳. 替羅非班治療非ST段抬高型急性冠脈綜合征的臨床觀察. 中國初級衛生保健, 2011, 25(9):84-85.
12. 趙偉, 龐志華. 非ST段抬高型急性冠狀動脈綜合征患者應用國產替羅非班的療效觀察.實用臨床醫藥雜志, 2012, 16(1):42-44.
13. 張健, 石宇杰, 崔俊玉, 等. 鹽酸替羅非班治療非ST段抬高急性冠脈綜合征的臨床療效.中國循證心血管醫學雜志, 2012, 4(1):18-19.
14. 邱惠, 張宇晨, 王雷, 等. 替羅非班對非ST段抬高急性冠脈綜合征的治療作用. 北京醫學, 2009, 31(2):65-67.
15. 高艷霞, 李凌, 劉懷霖, 等. 替羅非班治療非ST段抬高型急性心肌梗死臨床觀察. 鄭州大學學報(醫學版), 2009, 44(2):406-408.
16. 李昌, 林琍, 宗文霞. 替羅非班治療不穩定型心絞痛和非ST段抬高心肌梗死49例. 中國藥業, 2009, 18(7):41-42.
17. 丁智曉, 任建民, 劉曉梅. 替羅非班治療非ST段抬高急性冠脈綜合征的臨床觀察. 重慶醫學, 2009, 38(12):1487-1488.
18. 王建玲, 王敬萍, 王日軍. 替羅非班治療非ST段抬高型急性冠狀動脈綜合征的臨床觀察. 中國藥物與臨床, 2010, 10(1):77-78.
19. 楊昌林, 劉呂紅.國產替羅非班治療老年急性非ST段抬高型心肌梗死臨床觀察.現代中西醫結合雜志, 2010, 19(10):1192-1193.
20. 朱玲軍, 林文輝, 張凌志.替羅非班治療急性非ST抬高型心肌梗死的療效和安全性評價. 海峽藥學, 2011, 23(8):115-117.
21. 許勇. 鹽酸替羅非班治療非ST段抬高急性冠狀動脈綜合征40例臨床療效觀察. 中國醫藥指南, 2012, 10(22):41-42.
22. 盧云飛. 替羅非班治療非ST段抬高型急性冠脈綜合征78例的臨床研究. 貴陽中醫學院學報, 2012, 34(5):82-85.
23. 王曉陽. 小劑量替羅非班治療高齡非ST段抬高急性冠狀動脈綜合征患者的療效及安全性.中國醫藥指南, 2012, 10(33):429-430.
24. 楊遇春, 吳明祥, 張治平, 等. 新型國產替羅非班在非介入治療的急性非ST段抬高型心肌梗死患者的療效與安全性觀察. 中國美容醫學, 2012, 21(10):252-253.
25. 陳靜波. 鹽酸替羅非班治療非ST段抬高急性冠脈綜合征的療效與安全性. 中國醫學工程, 2013, 21(2):174-175.
26. 林高平. 替羅非班對非ST段抬高性急性冠脈綜合征的療效觀察. 中外醫學研究, 2013, 11(6):25-26.
27. 李杰. 替羅非班治療老年非ST段抬高急性冠脈綜合征的臨床療效觀察. 中國臨床研究, 2013, 26(4):334-335.
28. 梁莉. 替羅非班治療老年非ST段抬高急性冠脈綜合征的療效觀察. 臨床軍醫雜志, 2013, 41(4):338-339, 346.
29. 吉小利, 陳桂芬, 訾娟. 替羅非班對急性非ST段抬高心肌梗死患者近期臨床預后的影響. 山東醫藥, 2011, 51(13):81-82.
30. 徐成斌. ACS的病理與病理生理學. 中國原刊, 2001, 36(11):6-7.
31. PRISM Study Investigators. A comparision of aspirin plus tirofiban with aspirin plus heparin for unstable angina. Platelet receptor inhibition in ischemic syndrome management. N Engl J Med, 1998, 338(21):1498-1505.
32. PRISM-PLUS Study Investigators. Platelet receptor inhibition in ischemic syndrome management in patients limited by unstable signs and symptoms. N Engl J Med, 1998, 338(21):1488-1497.
33. 王兆鉞. 抗血小板藥的臨床應用. 中華內科雜志, 2007, 46(11):958-959.
34. 申華, 周玉杰. 2011歐洲心臟病學會非ST段抬高型急性冠脈綜合征處理指南更新解讀.中國醫學前沿雜志(電子版), 2011, 3(5):97-99.
35. 廖業敏, 程芝俏. 氯吡格雷、阿司匹林和低分子肝素聯用對急性非ST段抬高心肌梗死的療效分析.中國心血管病研究雜志, 2007, 5(1):33-35.
36. 趙新華. 氯吡格雷與拜阿司匹林和低分子肝素鈣治療非ST段抬高型心肌梗死36例臨床觀察. 臨床醫藥實踐. 2010, 19(12):961-962.
37. 中華心血管病雜志編輯委員會. 2013抗血小板治療中國專家共識. 2013, 41(3):183-194.
38. Cannon CP. Small molecule glycoprotein Ⅱb/Ⅲa receptor inhibitors as upstream therapy in acute coronary syndromes:insights from the TACTICS TIMI-18 trial. J Am Coll Cardiol, 2003, 41(4):43-48.
39. Steinhub SR, Moliterno DJ. Glycoprotein IIb/IIIa receptor and tag on it for the treatment of unstable angina. Heart Vessels, 1997, (Supp l 12):148-155.
40. 董蔚, 陳韻岱, 錢庚, 等. 國產替羅非班在急性冠狀動脈綜合征應用注冊研究. 中華內科雜志, 2013, 52(10):815-818.

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Effectiveness and Safety of Domestic Tirofiban for Chinese Population with Non-ST-elevation Acute Coronary Syndrome: A Meta-analysis

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