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Pharmacy World and Science

, Volume 26, Issue 1, pp 38–43 | Cite as

Tirofiban and eptifibatide treatment of patients presenting with acute coronary syndrome with non-ST segment elevation

  • Nuria Corominas
  • Josep Ribas
  • Joaquin Perez
  • Jose Ortiz
  • Elena Ferrer
  • Gines Sanz
Article

Abstract

Objective: This retrospective study was conducted to determine the usage patterns and tolerability of tirofiban and eptifibatide during the first year of their use.

Methods: We have assessed the appropriate use of these drugs according to the criteria implemented by the Clinical Institute of Cardiovascular Disease as part of a protocol for treating acute coronary syndrome with non-ST segment elevation.

Results: 37 patients received tirofiban and 19 patients received eptifibatide. These patients were at high risk of poor outcomes such as myocardial infarction or death. Tirofiban and eptifibatide were used according to the indication criteria: only one case fell outside them. Dosing, time for drug initiation (from last chest pain) and time of infusion were considered appropriate. Tirofiban was involved in two cases of minor bleeding complications and eptifibatide in one case of thrombocytopenia (80,000 platelets per millimeter). These mild adverse drug reactions were reversible with the early withdrawal of the drugs.

Conclusions: This study shows that tirofiban and eptifibatide have been used optimally, with a close adherence to the pre-established protocol. Both drugs have shown a good level of tolerability.

Appropriate use Drug utilization Drug utilization review Eptifibatide Glycoprotein IIb/IIIa receptors inhibitors Hospital pharmacy Guidelines adherence Spain Tirofiban 

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References

  1. 1.
    The TIMI IIIB Investigators. Effects of tissue plasminogen activator and a comparison of early invasive and conservative strategies in unstable angina and non-Q-wave myocardial infarction: results of the TIMI IIIB Trial. Circulation 1994; 89: 1545–56.Google Scholar
  2. 2.
    The CAPTURE investigators. Randomized placebo-controlled trial of abciximab before and during coronary intervention in refractory unstable angina. Lancet 1997; 349: 1429–35.Google Scholar
  3. 3.
    Cohen M, Demers C, Gurfinkel EP, Turpi AG, Fromell GJ, bxGodman S et al. A comparison of low-molecular-weight heparin with unfractionated heparin for unstable coronary artery disease. N Engl J Med 1997; 337: 447–52.Google Scholar
  4. 4.
    The PRIMS-PLUS Study Investigators. Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable angina and non-Q-wave myocardial infarction. N Engl J Med 1998; 338: 1488–97.Google Scholar
  5. 5.
    The PURSUIT Trial Investigators. Inhibition of platelet glycoprotein IIb/IIIa with eptifibatide in patients with acute coronary syndromes. N Engl J Med 1998; 339: 436–43.Google Scholar
  6. 6.
    The PRISM Study Investigators. A comparison of aspirin plus tirofiban with aspirin plus heparin for unstable angina. N Engl J Med 1998; 338: 1498–505.Google Scholar
  7. 7.
    Braunwald E, Jones RH, Mark DB, Brown J, Brown L, Cheitlin MD et al. Diagnosing and managing unstable angina. Circulation 1994; 90: 613–22.Google Scholar
  8. 8.
    Cockcroft DW, Gault MH. Prediction of creatinine clearence from serum creatinine. Nephron 1976; 16: 31–41.Google Scholar
  9. 9.
    Chesebro JH, Knatterud G, Roberts R, Borer J, Cohen LS, Dalen J et al. Thrombolysis in Myocardial Infarction (TIMI) Trial, phase I: a comparison between intravenous tissue plasminogen activator and intravenous streptokinase; clinical findings through hospital discharge. Circulation 1987; 76: 142–54.Google Scholar
  10. 10.
    Antman EM, Tanasijevic MJ, Thompson B, Schactman M, McCabe CH, Cannon CP et al. Cardiac-specific troponin I levels to predict the risk of mortality in patients with acute coronary syndromes. N Engl J Med 1996; 335: 1342–9.Google Scholar
  11. 11.
    Heeschen C, Hamm CW, Goldmann B, Deu A, Langenbrink L, White HD. For the PRISM Study Investigators. Troponin concentrations for stratification of patients with acute coronary syndromes in relation to therapeutic efficacy of tirofiban. Lancet 1999; 354: 1757–62.Google Scholar
  12. 12.
    Theroux P, Alexander J, Pharand C, Barr E, Snapinn S, Channam AF et al. Glycoprotein IIb/IIIa receptor blockade improves outcomes in diabetic patients presenting with unstable angina/non-ST-elevation myocardial infarction: results from platelet receptor inhibitor in ischemic syndrome management in Patients Limited by Unstable Signs and Symtoms (PRISM-PLUS) study. Circulation 2000; 102: 2466–72.Google Scholar
  13. 13.
    The EPIC Investigators. Use of a monoclonal antibody directed against the platelet glycoprotein IIb/IIIa receptor in high-risk coronary angioplasty. N Engl J Med 1994; 330: 956–61.Google Scholar
  14. 14.
    Boersma E, Pieper KS, Steyerberg EW, Wilcox RG, Chang WC, Lee KL. Predictors of oucome in patients with acute coronary syndromes without persistent ST-segment elevation: results from an international trial of 9461 patients. Circulation 2000; 101: 2557–67.Google Scholar
  15. 15.
    Bhatt DL, Marso SP, Houghtaling. Does earlier administration of eptifibatide reduce death and MI in patients with acute coronary syndromes? Circulation 1998; 98(Suppl): I–560.Google Scholar
  16. 16.
    Vaitkus PT. Currrent status of prevention, diagnosis, and management of coronary artery disease in patients with kidney failure. Am Heart J 2000; 139: 1000–8.Google Scholar
  17. 17.
    Traub SL. The kidneys. In: Traub SL, editor. Basic Skills in Interpreting Laboratory Data. 2nd ed. Bethesda, Maryland: ASHP, 1996: 131–57.Google Scholar
  18. 18.
    Köhler GI, Bode-Böger SM, Busse R, Hoopmann M, Weite T, Böger RH. Drug-drug interactions in medical patients: effects of in-hospital treatment and relation to multiple drug use. Int J Clin Pharmacol Ther 2000; 38: 504–13.Google Scholar
  19. 19.
    Cohen M, Theroux P, Weber S, Laramee P, Borzac S, Diodadi JG. Evaluation of combination therapy with tirofiban and enoxaparin in patients with unstable angina and non-Q-wave myocardial infarction. Eur Heart J 1999; 20: 376.Google Scholar
  20. 20.
    Cohen M. Initial experience with the low-molecular-weight heparin, enoxaparin, in combination with the platelet glycoprotein IIb/IIIa blocker, tirofiban, in patients with non-ST segment elevation acute coronary syndromes. J Invasive Cardiol 2000; 12(Suppl E): 5–9.Google Scholar
  21. 21.
    Cohen M, Demers C, Gurfinkel EP, Turpie AG, Fromell GJ, Goodman S et al. A comparison of low-molecular-weight-heparin with unfractionated heparin for unstable coronary artery disease. N Engl J Med 1997; 337: 447–52.Google Scholar
  22. 22.
    Antman EM, McCabe CH, Gurfinkel EP, Turpie AG, Bernink PJ, Salein D. Enoxaparin prevents death and cardiac ischemic events in unstable angina/non-Q-wave myocardial infarction. Circulation 1999; 100: 1593–601.Google Scholar
  23. 23.
    The INTERACT Trial Investigators. Randomized evaluation of the safety and efficacy of enoxaparin versus unfractionated heparin in high-risk patients with non-ST-segment elevation acute coronary syndromes receiving the glycoprotein IIb/IIIa inhibitor eptifibatide. Circulation 2003; 107: 238–44.Google Scholar

Copyright information

© Kluwer Academic Publishers 2004

Authors and Affiliations

  • Nuria Corominas
    • 1
  • Josep Ribas
    • 1
  • Joaquin Perez
    • 2
  • Jose Ortiz
    • 2
  • Elena Ferrer
    • 2
  • Gines Sanz
    • 2
  1. 1.Pharmacy DepartmentHospital ClinicBarcelonaSpain
  2. 2.Clinical Institute of Cardiovascular DiseasesHospital ClinicBarcelonaSpain

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