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Platelet glycoprotein IIb/IIIa inhibitor tirofiban in clopidogrel-naïve patients undergoing elective percutaneous

Zarina Habibi1,2, Jasper Luijkx3,4, Ben C G Gho3

  • 1Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands. z.habibi@maastrichtuniversity.nl.

Netherlands Heart Journal : Monthly Journal of the Netherlands Society of Cardiology and the Netherlands Heart Foundation
|September 15, 2023
PubMed

Insights

Tirofiban followed by a clopidogrel loading dose is safe for patients undergoing ad-hoc percutaneous coronary intervention (PCI). This strategy showed comparable safety outcomes to elective PCI with clopidogrel pretreatment.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Pharmacology

Background:

  • The safety of tirofiban (a platelet glycoprotein IIb/IIIa inhibitor) followed by a clopidogrel loading dose in clopidogrel-naïve patients undergoing ad-hoc percutaneous coronary intervention (PCI) remains unclear.
  • Ad-hoc PCI involves immediate intervention without prior planning, necessitating rapid and effective antiplatelet strategies.

Purpose of the Study:

  • To evaluate the safety and efficacy of administering tirofiban followed by a clopidogrel loading dose in clopidogrel-naïve patients undergoing ad-hoc PCI.
  • To compare major adverse cardiovascular events (MACE) in patients receiving this strategy versus those undergoing elective PCI with clopidogrel pretreatment.

Main Methods:

  • A retrospective observational cohort study compared 432 clopidogrel-naïve patients undergoing ad-hoc PCI (group 1: tirofiban bolus + clopidogrel loading dose) with 972 patients undergoing elective PCI (group 2: clopidogrel pretreatment).
  • The primary outcome was 30-day MACE (death, myocardial infarction, stroke, target-lesion revascularisation, bleeding). Secondary outcomes included 7-day MACE and individual event components.

Main Results:

  • At 30 days, MACE occurred in 1.9% of group 1 versus 4.2% of group 2 (p=0.03).
  • At 7 days, MACE occurred in 1.4% of group 1 versus 3.0% of group 2 (p=0.08).
  • Adjusted Cox regression analysis showed no significant difference in the primary outcome between the groups (HR: 1.8; 95% CI: 0.8-3.9).

Conclusions:

  • The administration of a high-dose tirofiban bolus followed by a clopidogrel loading dose immediately after ad-hoc PCI appears safe in clopidogrel-naïve patients.
  • This strategy demonstrated comparable safety to elective PCI with clopidogrel pretreatment, suggesting its potential utility in specific clinical scenarios.
Abstract

Keywords:
ClopidogrelElective percutaneous coronary interventionStable angina pectorisTirofiban

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