Safety evaluation of tirofiban.
BACKGROUND
Heightened platelet activity is pivotal in the thrombosis underlying acute coronary syndrome (ACS). The glycoprotein IIb/IIIa inhibitor tirofiban is a powerful platelet inhibitor with demonstrated efficacy and safety across the spectrum of ACS. Despite tirofiban's impact on the platelet compared with placebo, only an excess in minor and importantly not major bleeding has been observed. Thrombocytopenia with tirofiban seems to be extremely rare and immediately reversible on infusion discontinuation.


METHODS
The review includes the rationale for potent antiplatelet therapy in the management of ACS, particularly patients at high risk for ischemic complications. Additionally, it provides an overview of tirofiban's pharmacology and summary of the clinical efficacy and safety data of two dosing regimens.


RESULTS
The reader will gain a perspective on the efficacy and safety data from the key trials of tirofiban.


CONCLUSIONS
Tirofiban is safe and effective in patients with ACS. The single bolus dose regimen produces potent platelet inhibition resulting in significant improvement in clinical events over placebo when initiated just prior to percutaneous coronary intervention and at first medical contact. When compared with abciximab, tirofiban demonstrates similar efficacy though significantly lower rates of thrombocytopenia.
Valgimigli
Marco
M
Chair of Cardiology, Cardiovascular Institute, Azienda Opedaliera Universitaria di Ferrara, Arcispedale S. Anna C.so, Giovecca 203, 44100 Ferrara, Italy. valgmrc@unife.it
Tebaldi
Matteo
M
D000077284:Abciximab; D054058:Acute Coronary Syndrome / Q000097:blood / Q000188:drug therapy*; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D004311:Double-Blind Method; D004351:Drug Resistance; D006470:Hemorrhage / Q000139:chemically induced* / Q000453:epidemiology; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D015994:Incidence; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D015539:Platelet Activation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D016032:Randomized Controlled Trials as Topic / Q000706:statistics & numerical data; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000453:epidemiology; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D000077466:Tirofiban; D014443:Tyrosine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D014443:Tyrosine; D000077144:Clopidogrel; D000077466:Tirofiban; D013988:Ticlopidine; D001241:Aspirin; D000077284:Abciximab