Variability in Extent of Platelet Function Inhibition After Administration of Optimal Dose of Glycoprotein IIb/IIIa Receptor Blockers in Patients Undergoing a High-Risk Percutaneous Coronary Intervention

A randomized trial assessing the impact of three different glycoprotein IIb/IIIa antagonists on glycoprotein IIb/IIIa platelet receptor inhibition and clinical endpoints in patients with acute coronary syndromes

“…There were no significant differences in the primary endpoint of platelet inhibition at ten minutes postbolus dose ( P =.085). This finding is different to that of Danzi et al., in which patients given tirofiban achieved the highest mean level of platelet inhibition at ten minutes of 95±5%, compared to 92±6% among those given eptifibatide, and 86±9% in the abciximab group . Patients given abciximab achieved a statistically significantly lower level of inhibition at 10 minutes compared to tirofiban ( P <.001) and eptifibatide ( P =.01) .…”

2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention

“…584,587-589,613-618,620 -626 Thus, recommendations about use of GP IIb/IIIa inhibitors are best construed as applying to those patients not at high risk of bleeding complications. Abciximab, double-bolus eptifibatide (180 mcg/kg bolus followed 10 minutes later by a second 180 mcg/kg bolus), and high-bolus dose tirofiban (25 mcg/kg) all result in a high degree of platelet inhibition, [627][628][629] have been demonstrated to reduce ischemic complications in patients undergoing PCI, 608,609,613,615,618 -621 and appear to lead to comparable angiographic and clinical outcomes. 630,631 Trials of GP IIb/IIIa inhibitors in the setting of STEMI and primary PCI were conducted in the era before routine stenting and DAPT.…”

Comparison of intracoronary versus intravenous administration of tirofiban in primary percutaneous coronary intervention

“…The second reason may be related with bolus dose of tirofiban, which is 10 μg/kg in our study. Subsequent dose ranging studies showed that increasing the tirofiban bolus dose from 10 to 25 μg/ kg provided an optimal level of platelet inhibition and might even lead to a more consistent platelet inhibition than abciximab (25,26). Ernst et al (27) evaluated the extent of platelet aggregation inhibition in patients with STEMI undergoing primary PCI with clopidogrel, abciximab, standard bolus dose of tirofiban (10 μg/kg) and high bolus dose of tirofiban (25 μg/kg).…”