Clinical efficacy and safety of tirofiban combined with conventional dual antiplatelet therapy in ACS patients undergoing PCI

Abstract

Challenges remain for clinicians over balancing the efficacy of active antithrombotic therapy and simultaneous bleeding reduction in patients. The clinical data of 347 patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) were retrospectively analyzed. On the basis of the given tirofiban, the patients were assigned into three different dose groups: high dose group (group H), medium dose group (group M), and low dose group (group L). The tirofiban efficacy was evaluated in terms of major adverse cardiovascular event (MACE) parameters and lab endpoints, including platelet count and function. The tirofiban safety was assessed by the occurrence of bleeding events. The patients were followed up for 1 month after the PCI. No significant difference in MACE events was evident among these groups (p > 0.05). Groups H and M reported an obvious reduction in platelet count (p < 0.05 for both) and an increased platelet inhibition rate (p < 0.05 for both). Group H showed a higher rate of total bleeding events than the other groups (Group H vs. Group M: 34.4% vs. 16.5%; Group H vs. Group L: 34.4% vs. 10.3%; p < 0.05 for both). A proper administration of a low dose of tirofiban may be a superior alternative in treating ACS patients, which can produce a similar favorable clinical outcome and a decrease in bleeding complication.

Anticoagulation Options for Cranial Procedures: A Comparative Review of Aspirin, Plavix, and Aggrastat

“…Aggrastat (Tirofiban) is a glycoprotein receptor antagonist, and it is administered intravenously [ 6 ]. It is a reversible, competitive inhibitor of the GPIIb/IIIa receptor, a platelet surface receptor involved in platelet aggregation [ 11 ]. It inhibits fibrinogen-dependent platelet aggregation and prolongs the bleeding time by preventing fibrinogen binding to the GPIIb/IIIa receptor [ 11 , 12 ].…”

“…The absorption rate of aspirin depends on gastric potential hydrogen (pH) and dosage form. The plasma level of uncoated formulation peaks in 30-40 minutes, whereas enteric-coated formulation peaks in three to four hours [ 10 , 11 ]. The plasma half-life of aspirin is 15-20 minutes [ 8 ].…”

“…The other 85% is hydrolyzed to inactive carboxylic acid derivatives by carboxylesterase 1 (CES1) [ 10 ]. Tirofiban induces its effect in a dose- and concentration-dependent manner, and its effect on platelet aggregation depends on its plasma concentration [ 11 ].…”

Early tirofiban versus heparin for bridging dual antiplatelet therapy in patients undergoing coronary endarterectomy combined with coronary artery bypass grafting: a multicenter randomized controlled trial protocol (the THACE-CABG trial)

“…Tirofiban is a small-molecule peptide that selectively inhibits fibrinogen–platelet GP IIb/IIIa binding and reduces ischemic events in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention [ 13 , 14 ]. Since perioperative use of GP IIb/IIIa inhibitors does not increase surgical bleeding after CABG [ 15 – 17 ], we hypothesized that early tirofiban administration before initiation of DAPT reduces the incidence of thrombosis and POMI after CE-CABG but does not increase bleeding incidence or severity.…”

Efficacy and safety of intracoronary versus intravenous tirofiban in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: A meta-analysis of randomized controlled trials

“…ST-segment elevation myocardial infarction (STEMI) is a severe type of acute coronary syndrome (ACS), accompanied by the activation of platelets and coagulation systems [ 1 ]. Timely symptomatic relief and prevention of complications are particularly important for the treatment of STEMI patients, primary percutaneous coronary intervention (PPCI) is currently the main method of early reperfusion therapy which can improve the prognosis of STEMI patients.…”