Safety and efficacy of early administration of tirofiban in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention: A meta-analysis

Chinese medical journal (Impact Factor: 1.05). 03/2014; 127(6):1126-32. DOI: 10.3760/cma.j.issn.0366-6999.20131795
Source: PubMed


Tirofiban has been widely used as an adjunctive pharmacologic agent for revascularization in patients undergoing percutaneous coronary intervention, and the outcomes appear attractive. However, the potential benefits from early administration of tirofiban in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) remain unclear.
We conducted a search in MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials up to September 2012 without language restriction. A total of eight randomized trials (n = 1 577 patients) comparing early (emergency department or ambulance) versus late (catheterization laboratory) administration of tirofiban in STEMI patients undergoing PPCI were included in this meta-analysis. Risk ratio (RR) was computed from individual studies and pooled with random- or fixed-effect models.
There were no differences in post-procedural Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 and Corrected TIMI Frame Count (RR = 1.02, 95% confidence interval (CI): 0.99-1.05, P = 0.18; weighted mean difference (WMD) = -0.93, 95% CI: -5.37-3.52, P = 0.68, respectively) between the two groups. Similarly, there were no significant differences in the incidence of 30-day mortality (RR = 1.69, 95% CI: 0.69-4.13, P = 0.25) and re-myocardial infarction (RR = 0.71, 95% CI: 0.21-2.35, P = 0.57) between early and late administration of tirofiban. As to the safety end points, no significant difference was observed in hospital minor bleeding (RR = 1.08, 95% CI: 0.54-2.14, P = 0.83) and hospital and 30-day major bleeding between the two groups (RR = 0.98, 95% CI: 0.46-2.10, P = 0.96; RR = 1.32, 95% CI: 0.59-2.97, P = 0.49, respectively).
Early administration of tirofiban in patients undergoing PPCI for STEMI was safe, but no beneficial effects on post-procedural angiographic or clinical outcomes could be identified as compared with late administration. Besides the negative finding, more high-quality randomized clinical trials are still needed to explore the efficacy of adequate, earlier administration of tirofiban in patients undergoing PPCI.

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    ABSTRACT: Introduction: Tissue perfusion plays an important role in pancreatitis. Free oxygen radicals also have some triggering roles in the severity of acute pancreatitis. Tirofiban hydrochloride (TH) is being used for ischemic disorders for many years and is known as an antiaggregant drug. We aimed to determine the therapeutic effects of tirofiban in cerulein-induced acute pancreatitis in this animal study. Materials and methods: Twenty-four Wistar-Albino male rats were divided into three equal groups; Group I: Sham-operated group, Group II: cerulein induced pancreatitis group, Group III: cerulein induced pancreatitis + treatment group (intraperitoneal 0.25 mg tirofiban hydrochloride in 1 ml isotonic saline solution). Amylase and lipase levels were studied in blood samples and malondialdehyde, glutathione peroxidase and superoxide dismutase activities were measured in tissue samples. Results: Amylase and lipase levels were elevated in acute pancreatitis group. The levels of both enzymes were decreased after the rats were medicated with TH. Malondialdehyde (MDA) was higher in pancreatitis group without treatment. There were no significant differences between groups according to glutathione peroxidase (GSH-Px) and superoxide dismutase (SOD) levels. Conclusion: The present findings suggest that TH has an antiaggregant effect and may reduce the progression and improve the healing of acute pancreatitis. Key words: Acute pancreatitis, reactive oxygen species, Tirofiban hydrochloride, Glycoprotein IIb-IIIa inhibitor.
    Full-text · Article · Mar 2015 · Acta Medica Mediterranea