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.	国际心脏病学会和协会及世界卫生组织命名标准化联合专题组. 缺血性心脏病的命名及诊断标准.中华心血管病杂志, 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. 替罗非班治疗急性非ST段抬高心肌梗死的临床观察. 中国现代药物应用, 2008, 2(24):67-68.
8.	刘华东. 替罗非班在药物治疗非ST段抬高型心肌梗死中的疗效及安全性观察. 山东医药, 2008, 48(27):94-95.
9.	张璟轶, 熊世熙, 龚雯. 替罗非班治疗非ST段抬高急性冠状动脉综合征的临床观察. 医学新知杂志, 2008,18(5):276-277, 279.
10.	黄红梅, 李俐. 替罗非班治疗老年非ST段抬高急性冠脉综合征的临床研究. 中国循证心血管医学杂志, 2011, 3(1):41-43.
11.	李章伟, 韩笑, 郑琳. 替罗非班治疗非ST段抬高型急性冠脉综合征的临床观察. 中国初级卫生保健, 2011, 25(9):84-85.
12.	赵伟, 庞志华. 非ST段抬高型急性冠状动脉综合征患者应用国产替罗非班的疗效观察.实用临床医药杂志, 2012, 16(1):42-44.
13.	张健, 石宇杰, 崔俊玉, 等. 盐酸替罗非班治疗非ST段抬高急性冠脉综合征的临床疗效.中国循证心血管医学杂志, 2012, 4(1):18-19.
14.	邱惠, 张宇晨, 王雷, 等. 替罗非班对非ST段抬高急性冠脉综合征的治疗作用. 北京医学, 2009, 31(2):65-67.
15.	高艳霞, 李凌, 刘怀霖, 等. 替罗非班治疗非ST段抬高型急性心肌梗死临床观察. 郑州大学学报(医学版), 2009, 44(2):406-408.
16.	李昌, 林琍, 宗文霞. 替罗非班治疗不稳定型心绞痛和非ST段抬高心肌梗死49例. 中国药业, 2009, 18(7):41-42.
17.	丁智晓, 任建民, 刘晓梅. 替罗非班治疗非ST段抬高急性冠脉综合征的临床观察. 重庆医学, 2009, 38(12):1487-1488.
18.	王建玲, 王敬萍, 王日军. 替罗非班治疗非ST段抬高型急性冠状动脉综合征的临床观察. 中国药物与临床, 2010, 10(1):77-78.
19.	杨昌林, 刘吕红.国产替罗非班治疗老年急性非ST段抬高型心肌梗死临床观察.现代中西医结合杂志, 2010, 19(10):1192-1193.
20.	朱玲军, 林文辉, 张凌志.替罗非班治疗急性非ST抬高型心肌梗死的疗效和安全性评价. 海峡药学, 2011, 23(8):115-117.
21.	许勇. 盐酸替罗非班治疗非ST段抬高急性冠状动脉综合征40例临床疗效观察. 中国医药指南, 2012, 10(22):41-42.
22.	卢云飞. 替罗非班治疗非ST段抬高型急性冠脉综合征78例的临床研究. 贵阳中医学院学报, 2012, 34(5):82-85.
23.	王晓阳. 小剂量替罗非班治疗高龄非ST段抬高急性冠状动脉综合征患者的疗效及安全性.中国医药指南, 2012, 10(33):429-430.
24.	杨遇春, 吴明祥, 张治平, 等. 新型国产替罗非班在非介入治疗的急性非ST段抬高型心肌梗死患者的疗效与安全性观察. 中国美容医学, 2012, 21(10):252-253.
25.	陈静波. 盐酸替罗非班治疗非ST段抬高急性冠脉综合征的疗效与安全性. 中国医学工程, 2013, 21(2):174-175.
26.	林高平. 替罗非班对非ST段抬高性急性冠脉综合征的疗效观察. 中外医学研究, 2013, 11(6):25-26.
27.	李杰. 替罗非班治疗老年非ST段抬高急性冠脉综合征的临床疗效观察. 中国临床研究, 2013, 26(4):334-335.
28.	梁莉. 替罗非班治疗老年非ST段抬高急性冠脉综合征的疗效观察. 临床军医杂志, 2013, 41(4):338-339, 346.
29.	吉小利, 陈桂芬, 訾娟. 替罗非班对急性非ST段抬高心肌梗死患者近期临床预后的影响. 山东医药, 2011, 51(13):81-82.
30.	徐成斌. ACS的病理与病理生理学. 中国原刊, 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.	王兆钺. 抗血小板药的临床应用. 中华内科杂志, 2007, 46(11):958-959.
34.	申华, 周玉杰. 2011欧洲心脏病学会非ST段抬高型急性冠脉综合征处理指南更新解读.中国医学前沿杂志(电子版), 2011, 3(5):97-99.
35.	廖业敏, 程芝俏. 氯吡格雷、阿司匹林和低分子肝素联用对急性非ST段抬高心肌梗死的疗效分析.中国心血管病研究杂志, 2007, 5(1):33-35.
36.	赵新华. 氯吡格雷与拜阿司匹林和低分子肝素钙治疗非ST段抬高型心肌梗死36例临床观察. 临床医药实践. 2010, 19(12):961-962.
37.	中华心血管病杂志编辑委员会. 2013抗血小板治疗中国专家共识. 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, 陈韵岱, 钱庚, 等. 国产替罗非班在急性冠状动脉综合征应用注册研究. 中华内科杂志, 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. 国际心脏病学会和协会及世界卫生组织命名标准化联合专题组. 缺血性心脏病的命名及诊断标准.中华心血管病杂志, 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. 替罗非班治疗急性非ST段抬高心肌梗死的临床观察. 中国现代药物应用, 2008, 2(24):67-68.
8. 刘华东. 替罗非班在药物治疗非ST段抬高型心肌梗死中的疗效及安全性观察. 山东医药, 2008, 48(27):94-95.
9. 张璟轶, 熊世熙, 龚雯. 替罗非班治疗非ST段抬高急性冠状动脉综合征的临床观察. 医学新知杂志, 2008,18(5):276-277, 279.
10. 黄红梅, 李俐. 替罗非班治疗老年非ST段抬高急性冠脉综合征的临床研究. 中国循证心血管医学杂志, 2011, 3(1):41-43.
11. 李章伟, 韩笑, 郑琳. 替罗非班治疗非ST段抬高型急性冠脉综合征的临床观察. 中国初级卫生保健, 2011, 25(9):84-85.
12. 赵伟, 庞志华. 非ST段抬高型急性冠状动脉综合征患者应用国产替罗非班的疗效观察.实用临床医药杂志, 2012, 16(1):42-44.
13. 张健, 石宇杰, 崔俊玉, 等. 盐酸替罗非班治疗非ST段抬高急性冠脉综合征的临床疗效.中国循证心血管医学杂志, 2012, 4(1):18-19.
14. 邱惠, 张宇晨, 王雷, 等. 替罗非班对非ST段抬高急性冠脉综合征的治疗作用. 北京医学, 2009, 31(2):65-67.
15. 高艳霞, 李凌, 刘怀霖, 等. 替罗非班治疗非ST段抬高型急性心肌梗死临床观察. 郑州大学学报(医学版), 2009, 44(2):406-408.
16. 李昌, 林琍, 宗文霞. 替罗非班治疗不稳定型心绞痛和非ST段抬高心肌梗死49例. 中国药业, 2009, 18(7):41-42.
17. 丁智晓, 任建民, 刘晓梅. 替罗非班治疗非ST段抬高急性冠脉综合征的临床观察. 重庆医学, 2009, 38(12):1487-1488.
18. 王建玲, 王敬萍, 王日军. 替罗非班治疗非ST段抬高型急性冠状动脉综合征的临床观察. 中国药物与临床, 2010, 10(1):77-78.
19. 杨昌林, 刘吕红.国产替罗非班治疗老年急性非ST段抬高型心肌梗死临床观察.现代中西医结合杂志, 2010, 19(10):1192-1193.
20. 朱玲军, 林文辉, 张凌志.替罗非班治疗急性非ST抬高型心肌梗死的疗效和安全性评价. 海峡药学, 2011, 23(8):115-117.
21. 许勇. 盐酸替罗非班治疗非ST段抬高急性冠状动脉综合征40例临床疗效观察. 中国医药指南, 2012, 10(22):41-42.
22. 卢云飞. 替罗非班治疗非ST段抬高型急性冠脉综合征78例的临床研究. 贵阳中医学院学报, 2012, 34(5):82-85.
23. 王晓阳. 小剂量替罗非班治疗高龄非ST段抬高急性冠状动脉综合征患者的疗效及安全性.中国医药指南, 2012, 10(33):429-430.
24. 杨遇春, 吴明祥, 张治平, 等. 新型国产替罗非班在非介入治疗的急性非ST段抬高型心肌梗死患者的疗效与安全性观察. 中国美容医学, 2012, 21(10):252-253.
25. 陈静波. 盐酸替罗非班治疗非ST段抬高急性冠脉综合征的疗效与安全性. 中国医学工程, 2013, 21(2):174-175.
26. 林高平. 替罗非班对非ST段抬高性急性冠脉综合征的疗效观察. 中外医学研究, 2013, 11(6):25-26.
27. 李杰. 替罗非班治疗老年非ST段抬高急性冠脉综合征的临床疗效观察. 中国临床研究, 2013, 26(4):334-335.
28. 梁莉. 替罗非班治疗老年非ST段抬高急性冠脉综合征的疗效观察. 临床军医杂志, 2013, 41(4):338-339, 346.
29. 吉小利, 陈桂芬, 訾娟. 替罗非班对急性非ST段抬高心肌梗死患者近期临床预后的影响. 山东医药, 2011, 51(13):81-82.
30. 徐成斌. ACS的病理与病理生理学. 中国原刊, 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. 王兆钺. 抗血小板药的临床应用. 中华内科杂志, 2007, 46(11):958-959.
34. 申华, 周玉杰. 2011欧洲心脏病学会非ST段抬高型急性冠脉综合征处理指南更新解读.中国医学前沿杂志(电子版), 2011, 3(5):97-99.
35. 廖业敏, 程芝俏. 氯吡格雷、阿司匹林和低分子肝素联用对急性非ST段抬高心肌梗死的疗效分析.中国心血管病研究杂志, 2007, 5(1):33-35.
36. 赵新华. 氯吡格雷与拜阿司匹林和低分子肝素钙治疗非ST段抬高型心肌梗死36例临床观察. 临床医药实践. 2010, 19(12):961-962.
37. 中华心血管病杂志编辑委员会. 2013抗血小板治疗中国专家共识. 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, 陈韵岱, 钱庚, 等. 国产替罗非班在急性冠状动脉综合征应用注册研究. 中华内科杂志, 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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