Safety of High-dose Tirofiban in Patient Undergoing Coronary Angioplasty.

Background The acute occlusion due to intrastent thrombosis represented a major event causing acute myocardial infarction, cardiac death and necessity for a new procedure or coronary by-pass intervention.

To avoid such complications different high anticoagulation regimens (heparin, antiplatelets agents and warfarin) were employed. Even if effective, such treatments were accompanied by a higher cost of side effects due to major bleeding (hemorrhagic stroke, retroperitoneal bleeding, gastrointestinal bleeding, need for transfusion, site access complications).

Pre-treatment with aspirin and ticlopidine was found to be very effective reducing intrastent acute thrombosis. Since several days of pre-treatment were required it became a limiting factor for interventional procedures forcing physicians to adopt a two-stage strategy that separated the diagnostic from interventional time increasing the hospital's costs and the patient's risks.

Beside that, high doses of heparin were still required during the procedures. The introduction of GP IIb/IIIa inhibitors was initially reserved to acute coronary syndrome, later it was shown how they reduce the composite incidence of death, myocardial infarction and the need for target vessel revascularization after percutaneous coronary intervention.

As major benefits arising from the use of those drugs, interventional procedures could be carried out at end of diagnostic procedure and major bleedings were reduced as require a lower heparin regimen.