Tirofiban (Aggrastat)

Introduction

Tradename: Aggrastat.

Indications

• adjunctive agent with angioplasty (PTCA)*
• may be useful for acute coronary syndrome
  • without persistent ST segment elevation
• adjunctive agent with thrombolysis for ischemic stroke

* reserved for use at the time of percutaneous coronary intervention

Infusion:

• bolus: 10 ug/kg over 3 minutes
• infusion: 0.15 ug/kg/min
  • also heparin bolus 10,000 U or 150 U/kg if < 70 kg
  • mean duration of infusion 71 hours (Prism-Plus trial)

Contraindications

• active internal bleeding
• intracranial pathology
  • intracranial hemorrhage
  • intracranial neoplasm
  • arteriovenous malformation
  • aneurysm
• systolic blood pressure > 180 mm Hg
• diastolic blood pressure > 110 mm Hg
• acute pericarditis
• history of stroke
  • any history of hemorrhagic stroke
  • history of ischemic stroke within last 30 days (maybe not)
• major surgical procedure or severe trauma within the last 30 days

Adverse effects

• bleeding 17%
• pelvic pain 6%
• coronary artery dissection 5%
• bradycardia 4%

• drug adverse effects of antiplatelet agents
• drug adverse effects of glycoprotein IIb/IIIa inhibitor
• drug adverse effects of antithrombotic agent(s)

Mechanism of action

• inhibits glycoprotein IIb/IIIa receptor

More general terms

• amine
• glycoprotein IIb/IIIa inhibitor

Additional terms

• angioplasty; balloon angioplasty
• glycoprotein IIB/IIIA

Database

• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=60496
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=60497
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=5486
• PubChem: http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=64781