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Effect of low frequency ultrasound on combined rt-PA and eptifibatide thrombolysis in human clots.

Publication ,  Journal Article
Meunier, JM; Holland, CK; Pancioli, AM; Lindsell, CJ; Shaw, GJ
Published in: Thromb Res
2009

INTRODUCTION: Fibrinolytics such as recombinant tissue plasminogen activator (rt-PA) are used to treat thrombotic disease such as acute myocardial infarction (AMI) and ischemic stroke. Interest in increasing efficacy and reducing side effects has led to the study of adjuncts such as GP IIb-IIIa inhibitors and ultrasound (US) enhanced thrombolysis. Currently, GP IIb-IIIa inhibitor and fibrinolytic treatment are often used in AMI, and are under investigation for stroke treatment. However, little is known of the efficacy of combined GP IIb-IIIa inhibitor, fibrinolytic and ultrasound treatment. We measure the lytic efficacy of rt-PA, eptifibatide (Epf) and 120 kHz ultrasound treatment in an in-vitro human clot model. MATERIALS AND METHODS: Blood was drawn from 15 subjects after IRB approval. Clots were made in 20 microL pipettes, and placed in a water tank for microscopic visualization during lytic treatment. Clots were exposed to control, rt-PA (rt-PA), eptifibatide (Epf), or rt-PA+eptifibatide (rt-PA + Epf), with (+US) or without (-US) ultrasound for 30 minutes at 37 degrees C in human plasma. Clot lysis was measured over time, using a microscopic imaging technique. The fractional clot loss (FCL) and initial lytic rate (LR) were used to quantify lytic efficacy. RESULTS AND CONCLUSIONS: LR values for (- US) treated clots were 0.8+/-0.1(control), 1.8+/-0.3 (Epf), 1.5+/-0.2 (rt-PA), and 1.3+/-0.4 (rt-PA + Epf) (% clot width/minute) respectively. In comparison, the (+ US) group exhibited LR values of 1.6+/-0.2 (control), 4.3+/-0.4 (Epf), 6.3+/-0.4 (rt-PA), and 4.6+/-0.6 (rt-PA + Epf). For (- US) treated clots, FCL was 6.0+/-0.8 (control), 9.2+/-2.5 (Epf), 15.6+/-1.7 (rt-PA), and 28.0+/-2.2% (rt-PA + Epf) respectively. FCL for (+ US) clots was 13.5+/-2.4 (control), 20.7+/-6.4 (Epf), 44.4+/-3.6 (rt-PA) and 30.3+/-3.6% (rt-PA + Epf) respectively. Although the addition of eptifibatide enhances the in-vitro lytic efficacy of rt-PA in the absence of ultrasound, the efficacy of ultrasound and rt-PA is greater than that of combined ultrasound, rt-PA and eptifibatide exposure.

Duke Scholars

Published In

Thromb Res

DOI

ISSN

0049-3848

Publication Date

2009

Volume

123

Issue

3

Start / End Page

528 / 536

Location

United States

Related Subject Headings

  • Ultrasonic Therapy
  • Tissue Plasminogen Activator
  • Thrombosis
  • Thrombolytic Therapy
  • Recombinant Proteins
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Platelet Aggregation Inhibitors
  • Peptides
  • In Vitro Techniques
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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Meunier, J. M., Holland, C. K., Pancioli, A. M., Lindsell, C. J., & Shaw, G. J. (2009). Effect of low frequency ultrasound on combined rt-PA and eptifibatide thrombolysis in human clots. Thromb Res, 123(3), 528–536. https://doi.org/10.1016/j.thromres.2008.05.011
Meunier, Jason M., Christy K. Holland, Arthur M. Pancioli, Christopher J. Lindsell, and George J. Shaw. “Effect of low frequency ultrasound on combined rt-PA and eptifibatide thrombolysis in human clots.Thromb Res 123, no. 3 (2009): 528–36. https://doi.org/10.1016/j.thromres.2008.05.011.
Meunier JM, Holland CK, Pancioli AM, Lindsell CJ, Shaw GJ. Effect of low frequency ultrasound on combined rt-PA and eptifibatide thrombolysis in human clots. Thromb Res. 2009;123(3):528–36.
Meunier, Jason M., et al. “Effect of low frequency ultrasound on combined rt-PA and eptifibatide thrombolysis in human clots.Thromb Res, vol. 123, no. 3, 2009, pp. 528–36. Pubmed, doi:10.1016/j.thromres.2008.05.011.
Meunier JM, Holland CK, Pancioli AM, Lindsell CJ, Shaw GJ. Effect of low frequency ultrasound on combined rt-PA and eptifibatide thrombolysis in human clots. Thromb Res. 2009;123(3):528–536.
Journal cover image

Published In

Thromb Res

DOI

ISSN

0049-3848

Publication Date

2009

Volume

123

Issue

3

Start / End Page

528 / 536

Location

United States

Related Subject Headings

  • Ultrasonic Therapy
  • Tissue Plasminogen Activator
  • Thrombosis
  • Thrombolytic Therapy
  • Recombinant Proteins
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Platelet Aggregation Inhibitors
  • Peptides
  • In Vitro Techniques
  • Humans