Platelet Function and Risk of Bleeding in Patients With Acute Coronary Syndrome Following Tirofiban Infusion

Abstract

Aim: To assess platelet (PLT) function and bleeding risks in patients with acute coronary syndrome after tirofiban infusion.Methods: Patients diagnosed with acute coronary syndrome from May 2016 to February 2018 in the Department of Cardiac Intensive Care Unit, Zhongshan Hospital, were enrolled. They were symmetrically allocated into two groups: tirofiban treatment group or control group (without tirofiban treatment). Blood samples were collected 24 h postoperation for the evaluation of antiplatelet effect of tirofiban. We applied thromboelastography to detect on-treatment PLT reactivity and conducted laboratory tests to assess the risk of bleeding following tirofiban treatment. After discharge, telephone follow-up and outpatient interview were carried out. The primary clinical endpoint was major adverse cardiovascular events, including cardiovascular death, cardiovascular mortality, myocardial infarction, and revascularization for the targeted vascular lesion.Results: There were a total of 196 patients with acute coronary syndrome after screening with the inclusion criteria and the exclusion criteria. Ninety-eight patients were assigned to receive either tirofiban treatment or control treatment. Patients treated with tirofiban had more coronary lesions and stents implanted compared with the control group (P = 0.000). After tirofiban infusion, inhibition of platelet aggregation induced by thromboxane A2 and adenosine diphosphate was significantly higher compared to patients without tirofiban infusion (80.3% ± 19.6% vs. 72.6% ± 13.0%, P = 0.002; and 81.0% ± 19.8% vs. 75.4% ± 12.4%, P = 0.020, respectively). There was no significant difference in the reduction of hemoglobin (Hb), hematocrit (Hct), and PLT after administration of tirofiban, compared with baseline (P > 0.05). In addition, no significant differences were identified between the two groups with respect to Hb, Hct, and PLT after tirofiban infusion. However, C-reactive protein level, referred to as an inflammation marker, was significantly lowered after infusion tirofiban compared with the control group (11.9 ± 14.2 vs. 17.9 ± 21.2, P = 0.020). During the 1-year follow-up, the incidence rate of major adverse cardiovascular events remains indiscriminate between the two groups (P = 0.208). The assessments of cardiac biomarkers showed that tirofiban could decrease incidence of procedural myocardial infarction (odds ratio [OR] = 0.250, 95% confidence interval [CI] = 0.067–0.925, P = 0.027). At follow-up, the morbidity of left atrial dilation in tirofiban-treated patients, defined as enlargement of left atrial diameter >40mm, was lower compared to the control group (OR = 0.533, 95% CI = 0.301–0.945, P = 0.031).Conclusion: Tirofiban infusion could decrease PLT activation in patients with acute coronary syndrome without increasing the risk of bleeding. As a concomitant medication, tirofiban shows no benefit in reducing the occurrence of major adverse cardiovascular events.

Effect of Tirofiban Injection on vascular endothelial function, cardiac function and inflammatory cytokines in patients with acute myocardial infarction after emergency Percutaneous Coronary Intervention

“…According to the study of Wang et al 21 , moderate doses of tirofiban have less side effects. Li et al also believed 22 that moderate doses of tirofiban would not increase the risk of bleeding in patients. It was confirmed in this study that FMD, NO, ET-1 and other indicators in the experimental group were significantly improved compared with the control Group-I week and 1 month after treatment, with a statistical significance ( p <0.05).…”

The blocking effect of the glycoprotein IIb/IIIa receptor in the mouse model of asthma

“…To the best of our knowledge, this is the first report regarding the blocking effect of GP IIb/IIIa in asthma. So far, tirofiban has been used primarily in heart and vascular diseases [ 30 , 31 ]. However, tirofiban has a therapeutic effect in chronic inflammatory diseases other than coronary disease by its involvement in the interaction between platelets and other blood cells [ 32 ].…”

Eficácia e segurança da ponte de tirofiban como alternativa à suspensão da terapia antiplaquetária dupla em pacientes submetidos à cirurgia: uma revisão sistemática

“…Therefore, the longer hospital stay and monitoring may be related to lower rates of bleeding, although the published data suggest that tirofiban infusion really does not interfere in the risk of bleeding during surgery. 40 …”

“…Outro fator possível para os desfechos favoráveis é que o protocolo ponte de tirofiban está relacionado com um acompanhamento mais minucioso do paciente no perioperatório, uma vez que a infusão se inicia entre 3 a 4 dias antes da cirurgia, sendo descontinuada apenas 4 horas antes do procedimento. Desse modo, o maior tempo de hospitalização e monitoramento pode estar relacionado às menores taxas de ocorrência de sangramentos, apesar de dados da literatura sugerirem que a infusão de tirofiban realmente não interfere no risco de sangramento na cirurgia 40 .…”