title: 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: BACKGROUND
  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).
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Li
authors.forename: Xianghua
authors.initials: X
authors.lastname: Fu
authors.forename: Haiwei
authors.initials: H
authors.lastname: Xue
authors.forename: Yanbo
authors.initials: Y
authors.lastname: Wang
authors.forename: Xuechao
authors.initials: X
authors.lastname: Wang
authors.forename: Yujun
authors.initials: Y
authors.lastname: Zhao
authors.forename: Wei
authors.initials: W
authors.lastname: Geng
authors.forename: Zengxin
authors.initials: Z
authors.lastname: Yang
authors.forename: Xinshun
authors.initials: X
authors.lastname: Gu
authors.forename: Guozhen
authors.initials: G
authors.lastname: Hao
authors.forename: Yunfa
authors.initials: Y
authors.lastname: Jiang
authors.forename: Weize
authors.initials: W
authors.lastname: Fan
authors.forename: Weili
authors.initials: W
authors.lastname: Wu
authors.forename: Shiqiang
authors.initials: S
authors.lastname: Li
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D061605:Administration, Intravenous; D000368:Aged; D016009:Chi-Square Distribution; D002681:China; D017023:Coronary Angiography; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects; D010974:Platelet Aggregation / Q000187:drug effects; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D000077466:Tirofiban; D016896:Treatment Outcome; D014443:Tyrosine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D014443:Tyrosine; D000077466:Tirofiban