Efficacy and safety of standard-dose versus half-dose tirofiban in patients with non-st elevation acute coronary syndromes undergoing early percutaneous coronary intervention

Abstract

Summary: Introduction: To explore the optimal dosage of tirofiban associated with double benefits of efficacy and safety in patients with non-ST elevation acute coronary syndromes (NSTE-ACS) undergoing early percutaneous coronary intervention (PCI). Aims: A total of 163 patients were included in this study (78 in SD group versus 85 in HD group). In SD (HD) group, tirofiban was administered intravenously with a bolus dose of 10 (5) μg/kg within 3 min and followed by continuous intravenous infusion of 0.15 (0.075) μg/kg/min for 48 h. Within 24 h on admission, patients underwent CAG or CAG+PCI. The angiographic results (initial TIMI, final TIMI/CTFC/TMPG) were evaluated. Platelet aggregation rate (PAR) was measured before and 2, 24, 48 h after bolus tirofiban. MACEs were evaluated at 7-day, 30-day, and 6-month follow-up. Bleeding was observed at 7 days. Results: The proportions of TIMI grade 3 seemed higher in SD group before and after PCI followed by a better myocardial perfusion, but not statistically different (P = 0.26/0.08). PAR was lower in SD group than that in HD group at 2 h after bolus tirofiban (P = 0.03). MACEs were not statistically different at 7, 30 day, and 6 month in two groups. The incidence of minor bleeding was significantly lower in HD group than that in SD group (8.2% vs. 20.5%, P = 0.04). The risk of bleeding would increase under the conditions of decreased PAR, increased dose of tirofiban and decreased CCr. Conclusion: Half-dose tirofiban was not inferior to standard-dose in efficacy, what is more, half-dose tirofiban showed a better safety characteristic of lower bleeding risk. Therefore, half-dose tirofiban is recommended to patients with NSTE-ACS undergoing early PCI. © 2012 John Wiley & Sons Ltd.