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3. Direct thrombin inhibitors in acute coronary syndromes: principal results of a meta-analysis based on individual patients' data

Author

Yusuf, S, Granger, C, Eikelboom, J, Mehta, S, Pogue, J, Tait, P, Behar, S, Benderly, M, Hod, H, Kaplinsky, E, Barrett, N, Bilke, R, Luz, M, Marhoefer, M, Roi, L, Trenery, D, Bittl, JA, Boersma, H, Flather, M, Baigent, C, Simoons, ML, Califf, R, Pieper, K, Topol, EJ, Weitz, J, Serruys, PW, White, HD, Neuhaus, KL, Zeymer, U, Simes, J, Close, P, Edwards, S, Gallo, P, Henis, M, Anand, S, Kimball, W, Meanwell, C, Villiger, J, Antman, EM, Braunwald, E, Gibson, M, Murphy, S, Grip, L, Held, P, Trialist, DTI, and Cardiology

Subjects
medicine.medical_specialty, medicine.medical_treatment, Hirudin, Glycine, Myocardial Infarction, Pharmacology, Arginine, Argatroban, Antithrombins, Piperidines, Hirudin Therapy, Internal medicine, medicine, Bivalirudin, Humans, Myocardial infarction, Angina, Unstable, Randomized Controlled Trials as Topic, Sulfonamides, business.industry, Heparin, Thrombin, Percutaneous coronary intervention, General Medicine, Hirudins, medicine.disease, Peptide Fragments, Recombinant Proteins, Survival Rate, Direct thrombin inhibitor, Pipecolic Acids, Cardiology, business, Oligopeptides, medicine.drug, Discovery and development of direct thrombin inhibitors
Abstract

BACKGROUND: To obtain more reliable and precise estimates of the effect of direct thrombin inhibitors in the management of acute coronary syndromes, including patients undergoing percutaneous coronary intervention, we undertook a meta-analysis based on individual patients' data from randomised trials comparing a direct thrombin inhibitor (hirudin, bivalirudin, argatroban, efegatran, or inogatran) with heparin. METHODS: We included trials that involved at least 200 patients. The primary efficacy outcome was death or myocardial infarction, and the primary safety outcome was major bleeding. Data from individual trials were combined by use of a modified Mantel-Haenszel method. FINDINGS: In 11 randomised trials, 35,970 patients were assigned up to 7 days' treatment with a direct thrombin inhibitor or heparin and followed up for at least 30 days. Compared with heparin, direct thrombin inhibitors were associated with a lower risk of death or myocardial infarction at the end of treatment (4.3% vs 5.1%; odds ratio 0.85 [95% CI 0.77-0.94]; p=0.001) and at 30 days (7.4% vs 8.2%; 0.91 [0.84-0.99]; p=0.02). This was due primarily to a reduction in myocardial infarctions (2.8% vs 3.5%; 0.80 [0.71-0.90]; p

Published
2002
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4. Adherence of pathogenic and non-pathogenic Entamoeba histolytica strains to neutrophils.

Author

Burchard, G. and Bilke, R.

Abstract

The adherence of polymorphonuclear leukocytes (PMNs) to eight pathogenic and nine nonpathogenic strains of Entamoeba histolytica was examined. No difference between pathogenic and nonpathogenic strains was found. The addition of different carbohydrates confirmed the importance of the 170-kDa lectin of E. histolytica in binding to PMNs, corroborated by the finding that treatment of PMNs with galactosidase inhibited adherence. Inhibition of the microfilament system of E. histolytica using cytochalasin B resulted in a loss of adherence to PMNs. Inhibition of the microtubule system using nocodazole did not affect adherence. Preincubation of the trophozoites with serum resulted in enbanced adherence, but the serum factor responsible for this effect could not be identified. Fibronectin, vitronectin, integrins (CD11/CD18 molecules), complement, and mannose-binding protein did not seem to mediate adherence between E. histolytica and PMNs. In summary, these results indicate that defective adherence mechanisms are not a common feature of nonpathogenic E. histolytica strains. [ABSTRACT FROM AUTHOR]

Published
1992
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