Comparison of ischemic and bleeding events between short versus long duration tirofiban regimens in patients with ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention

• Published in: Journal of cardiovascular pharmacology
• Main Authors: Denny, Olivia, Woodruff, Ashley E, Mills, Kevin, Chilbert, Maya R
• Format: Journal Article
• Language: English
• Published: United States 29.04.2022
• ISSN: 1533-4023

Tirofiban has been used historically as a bridge to platelet inhibition with clopidogrel in ST-segment myocardial infarction (STEMI) during percutaneous coronary intervention (PCI) to prevent stent thrombosis. However, ticagrelor and prasugrel reach similar levels of platelet inhibition at thirty minutes to that of clopidogrel at six hours, challenging the need for long duration tirofiban. This one-year, retrospective cohort study compared ischemic and bleeding outcomes of short versus long duration tirofiban regimens in patients with STEMI who received ticagrelor or prasugrel at the time of PCI. The primary outcome was major adverse cardiovascular events (MACE) including cardiovascular mortality, recurrent myocardial infarction, urgent target vessel revascularization, or stroke. Secondary outcomes included individual MACE, all-cause mortality, bleeding events defined by the International Society on Thrombosis and Haemostasis, thirty-day readmissions for MACE and bleeding, and tirofiban pharmacy cost. A total of 283 charts were reviewed and 177 included (short duration n=57; long duration n=120). MACE rates were similar between short and long duration groups (0 [0%] vs 5 [4.2%]; p=0.18), including four cardiovascular deaths and one recurrent myocardial infarction. Bleeding event rates were also similar in short versus long duration groups including major bleeds (2 [3.5%] vs 2 [1.7%]; p=0.60) and clinically relevant non-major bleeds (3 [5.3%] vs 9 [7.5%]; p=0.75). Cost analysis indicated lower pharmacy cost with the short duration group. In this cohort of patients with STEMI receiving a fast-acting P2Y12 inhibitor, the length of tirofiban infusion did not impact ischemic or bleeding outcomes, yet short duration regimens were lower cost.