Downstream administration of a high-dose tirofiban bolus in high-risk patients with unstable angina undergoing early percutaneous coronary intervention.

Abstract

BACKGROUND:

The best treatment option for high-risk patients with unstable coronary syndrome is an early invasive strategy accompanied by intensive anti-platelet therapy. We tested the effect on clinical outcome of early coronary angioplasty using a high-dose bolus of tirofiban in patients with non-ST segment elevation acute coronary syndrome.

METHODS:

One hundred and forty consecutive patients with unstable coronary syndrome who underwent an immediate percutaneous coronary intervention with the administration of a high (25 microg/kg) dose bolus of tirofiban followed by an 18-h infusion of 0.15 microg kg(-1) min(-1) were compared with a matched control group of 162 patients treated with abciximab. The primary endpoint of the study was the 30-day incidence of major adverse cardiac events; the secondary endpoints were the incidence of major and minor bleeding.

RESULTS:

The time from admission to PCI was slightly shorter in the tirofiban group (3.9+/-4.8 vs. 4.5+/-4.4 h; P=0.26). The 30-day rate of major adverse cardiac events was similar in the two groups (6% with tirofiban and 8.6% with abciximab: OR=1.37, 95% CI=0.58-3.29, P=0.52). No major bleeding episodes were observed; the incidence of minor bleeding was 3.6% in the tirofiban group and 2.5% in the abciximab group (OR=0.68, 95% CI=0.18-2.59, P=0.74).

CONCLUSIONS:

In this preliminary study, the beneficial effect of the administration of a high-dose tirofiban bolus on 30-day clinical outcomes was similar to that of abciximab in high-risk patients with unstable angina undergoing immediate percutaneous coronary intervention. The results of this therapeutic strategy should be tested in a larger randomised study.

• Authors: Gian B Danzi, Marco Sesana, Cinzia Capuano, Luigi Mauri, Simonetta Predolini, Roberto Baglini
• Journal: International journal of cardiology (Int J Cardiol) Vol. 107 Issue 2 Pg. 241-6 (Feb 15 2006) ISSN: 0167-5273 [Print] Netherlands
• PMID: 16412804 (Publication Type: Journal Article)

Chemical References

• Antibodies, Monoclonal
• Biomarkers
• Immunoglobulin Fab Fragments
• Platelet Aggregation Inhibitors
• Platelet Glycoprotein GPIIb-IIIa Complex
• Tyrosine
• Tirofiban
• Abciximab

Topics

• Abciximab
• Aged
• Angina, Unstable (blood, diagnostic imaging, therapy)
• Angioplasty, Balloon, Coronary (adverse effects)
• Antibodies, Monoclonal (administration & dosage)
• Biomarkers (blood)
• Case-Control Studies
• Confounding Factors, Epidemiologic
• Coronary Angiography
• Disease-Free Survival
• Dose-Response Relationship, Drug
• Electrocardiography
• Female
• Follow-Up Studies
• Humans
• Immunoglobulin Fab Fragments (administration & dosage)
• Male
• Middle Aged
• Platelet Aggregation Inhibitors (administration & dosage)
• Platelet Glycoprotein GPIIb-IIIa Complex (antagonists & inhibitors)
• Prospective Studies
• Risk Factors
• Time Factors
• Tirofiban
• Treatment Outcome
• Tyrosine (administration & dosage, analogs & derivatives)