title: High-dose tirofiban administered as bolus-only during percutaneous coronary intervention.
abstract: BACKGROUND
  Tirofiban administered at a bolus dose of 25 mcg/kg is associated with a higher level of platelet inhibition compared to that associated with the standard 10 mcg/kg tirofiban bolus dose. In our previous study on bolus-only glycoprotein IIb/IIIa receptor inhibition during percutaneous coronary intervention (PCI), the eptifibatide bolus-only group demonstrated similar efficacy, but significantly fewer bleeding complications compared to the abciximab bolus-only group.
  
  
  OBJECTIVE
  To compare the in-hospital outcomes of high-dose (25 mcg/kg) tirofiban bolusonly vs. eptifibatide double bolus-only during PCI. In addition, the degree of platelet inhibition achieved by this novel tirofiban dosing strategy was assessed.
  
  
  METHODS
  We retrospectively analyzed 876 consecutive patients who underwent PCI using a single high-dose bolus of tirofiban (25 mcg/kg) or eptifibatide (180 mcg/kg x 2, 10 minutes apart) from January 2003 to August 2005 in a single institution. Patients with ST-segment elevation myocardial infarction were excluded.
  
  
  RESULTS
  The percentage of platelet inhibition was 94% between 3-15 minutes post bolus of 25 mcg/kg of tirofiban. The platelet inhibition dropped to 92% at the end of the procedure (between 20-40 minutes) and to 74% at the time of sheath removal between 2-3 hours. After adjustment for the baseline and procedural characteristics, there was no difference in the composite endpoint of death, myocardial infarction, revascularization and bleeding complications (5.5% in tirofiban group vs. 5.3% in eptifibatide group; p = 0.79).
  
  
  CONCLUSIONS
  A single high-dose bolus of tirofiban rapidly achieves profound platelet inhibition and a significant antiplatelet effect is maintained until sheath removal. This dosing during PCI appears safe and compares favorably with eptifibatide bolus-only during PCI.
authors.affiliation: SUNY Health Science Center at Brooklyn, 450 Clarkson Avenue, Box 1257, Brooklyn, NY, 11203-2098, USA. jonathan@marmur.com
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Marmur
authors.forename: Shyam
authors.initials: S
authors.lastname: Poludasu
authors.forename: Ajay
authors.initials: A
authors.lastname: Agarwal
authors.forename: Nagarathna
authors.initials: N
authors.lastname: Manjappa
authors.forename: Erdal
authors.initials: E
authors.lastname: Cavusoglu
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000077542:Eptifibatide; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000628:therapy*; D010455:Peptides / Q000008:administration & dosage*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D012189:Retrospective Studies; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D010455:Peptides; D010975:Platelet Aggregation Inhibitors; D014443:Tyrosine; D000077466:Tirofiban; D000077542:Eptifibatide