Tirofiban and emergency coronary surgery.
The final common pathway of platelet aggregation leading to coronary thrombosis involves cross-linking of platelet receptor glycoprotein IIb-IIIa by primarily fibrinogen. Glycoprotein IIb-IIIa antagonists are being increasingly used as adjunctive therapy during percutaneous coronary intevention, and have shown to reduce the risk of death and myocardial infarction. However, a proportion of these patients continue to remain ischemic and present for emergency coronary grafting. The profound platelet inhibition in these patients enhances the already heightened risk of post-operative bleeding. With the recent approval of tirofiban for patients with acute coronary syndromes, the number of patients receiving tirofiban who subsequently undergo coronary artery bypass grafting is expected to increase substantially. Little clinical data exist, on patients who require immediate coronary artery grafting after receiving tirofiban. This article reviews the evidence for bleeding following tirofiban, discusses the relevant mechanism of action and pharmacodynamics, and analyses the strategies available in patients who need emergency coronary artery grafting after tirofiban.
Shanmugam
Ganesh
G
Department of Cardiac Surgery, Royal Hospital for Sick Children, Dalnair Street, Glasgow G3 8SJ, UK. sgunpat@hotmail.com
D000208:Acute Disease; D000284:Administration, Oral; D001792:Blood Platelets / Q000502:physiology; D001026:Coronary Artery Bypass / Q000379:methods*; D003327:Coronary Disease / Q000188:drug therapy* / Q000503:physiopathology / Q000601:surgery; D004630:Emergencies; D006801:Humans; D007262:Infusions, Intravenous; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects* / Q000494:pharmacology; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D019106:Postoperative Hemorrhage / Q000139:chemically induced; D013921:Thrombocytopenia / Q000139:chemically induced; D000077466:Tirofiban; D014443:Tyrosine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000494:pharmacology
D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; D000077466:Tirofiban