To overcome the suboptimal platelet inhibition induced by
tirofiban in the first hour after a
percutaneous coronary intervention, a new regimen of 25 microg/kg bolus followed by an 18-hr infusion of 0.15 microg/kg/min has been proposed. The aim of this study was to compare the effects of this high bolus dose of
tirofiban with those of
abciximab on
bleeding risk and 30-day clinical outcome in patients undergoing coronary stenting. We compared two cohorts of patients who underwent coronary
stent placement between January 2000 and December 2002. In the first cohort, the only available IIb/IIIa receptor inhibitor was
abciximab, which was given to 280 (34.9%) out of 802 stented patients; in the second cohort,
tirofiban was administered to 274 (38.3%) out of 716 treated patients. The primary endpoints were the proportion of patients with major
bleeding and the rate of site access complications; the 30-day incidence of
major adverse cardiac events (
MACE) was also assessed. After the procedure, the patients were given
ticlopidine for 4 weeks and
aspirin indefinitely. Major
bleeding episodes were observed in four patients receiving
abciximab and in none receiving
tirofiban (1.4% vs. 0%; P = 0.12); the rates of site access complications were similar (3.6% vs. 3.3%; P = 0.96). The 30-day incidence of
MACE was 7.1% in the
abciximab group and 5.8% in the
tirofiban group (P = 0.65). In patients undergoing coronary stenting, the high bolus dose of
tirofiban is safe and not associated with an increased risk of major
bleeding or site access complications in comparison with
abciximab.