Comparison in patients having primary coronary angioplasty of abciximab versus tirofiban on recovery of left ventricular function

Angiographic and Clinical Outcome in ST-Segment Elevation Myocardial Infarction Patients Receiving an Adjunctive Double Bolus Regimen of Tirofiban for Primary Percutaneous Coronary Intervention

“…13,17 Probably as a result of suboptimal early inhibition of platelets by tirofiban as compared with abciximab, 15 this dosing regimen was reported to be inferior to abciximab for protecting against death, nonfatal myocardial infarction, or urgent TVR. 14 In contrast, a higher dose (tirofiban 25 g/kg bolus followed by infusion at a rate 0.15 g·kg -1 ·min -1 ) that has better platelet aggregation inhibition than abciximab 18 can achieve similar efficacy to abciximab on initial angiographic results and 30-day recovery of left ventricular function in patients with STEMI 18 or acute coronary syndrome 19 undergoing primary PCI. As compared with placebo, Valgimigli et al also showed this high dosing regimen was able to significantly improve clinical and angiographic outcomes in patients undergoing high-risk PCI.…”

“…All of our study patients were Oriental and it is uncertain if there is a racial difference in the dose of tirofiban required for effective therapy. Thus, in addition to a different dosing regimen that might explain the differences between our results and others, [18][19][20]22 the severity of disease and racial difference need to be taken into consideration. However, the trend toward favoring the double bolus regimen to reduce the composite primary endpoints at 30-day (absolute reduction 4.9% and relative reduction 49%, p=0.171) and at 1-year follow-up (absolute reduction 7.1% and relative reduction 37.7%, p=0.151) (Table 3) suggests that with further refinement of the protocol, this regimen has a high potential adjunctive benefit.…”

“…In many studies, tirofiban was injected immediately before PCI in the catheterization laboratory, with inconsistent results. 10,[12][13][14][15][18][19][20][21][22] Early administration of tirofiban improved angiographic outcome in subjects undergoing PCI for AMI in the TIGER-PA Pilot trial. 17 The potential importance of the timing of administration is also consistent with another study 21 in which, if tirofiban was administered after angiographic study but just before PCI, angiographic outcomes in patients receiving low and high doses were similar, even though there was a clear dose-related platelet aggregation inhibition.…”

“…11 Results from studies of the efficacy of adjunctive tirofiban in patients undergoing PCI have been inconsistent. [12][13][14][15][16][17][18][19][20][21][22][23] Some have shown beneficial angiographic and clinical outcomes, 20,22 whereas others show either no benefit 16 or modest initial clinical improvements, unsustained at 30-day follow-up. 13,17 Interpretation of these results is difficult because different dosing regimens were used; for example, tirofiban was administered at a conventional dose (10 g/kg bolus followed by 0.15 g·kg -1 ·min -1 for 18-36 h) in some studies [12][13][14][15]17,[21][22][23] and in others 16,[18][19][20][21] at a high dose (20-25 g/kg bolus followed 0.15 g·kg -1 ·min -1 for 18-24 h).…”

“…The conventional dose of tirofiban may not achieve adequate platelet aggregation inhibition compared with abciximab. 14,15,24 Timing of the administration of tirofiban before PCI also varied, [12][13][14][15][16][17][18][19][20][21][22][23] and patients with different clinical scenarios of acute coronary syndrome were studied. These factors are all likely to influence the results and so it remains unclear what the optimal regimen of adjunctive tirofiban therapy would be for PCI in various patient populations.…”