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Antonio Urali - One of the best experts on this subject based on the ideXlab platform.
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randomized comparison of upstream Tirofiban versus downstream high bolus dose Tirofiban or abciximab on tissue level perfusion and troponin release in high risk acute coronary syndromes treated with percutaneous coronary interventions the everest tri
Journal of the American College of Cardiology, 2006Co-Authors: Leonardo Olognese, Giovanni Falsini, Francesco Liistro, Paolo Angioli, Kenneth Ducci, Tamara Taddei, Roberto Tarducci, Franco Cosmi, Silvia Aldassarre, Antonio UraliAbstract:Objectives We aimed to compare the effects of upstream Tirofiban versus downstream high-dose bolus (HDB) Tirofiban and abciximab on tissue level perfusion and troponin I release in high-risk non–ST-segment elevation acute coronary syndrome (ACS) patients treated with percutaneous coronary intervention (PCI). Background Optimal timing and dosage of glycoprotein IIb/IIIa inhibitors for ACS remain to be explored. Methods We randomized 93 high-risk ACS patients undergoing PCI to receive upstream (in the coronary care unit) Tirofiban, downstream (just prior to PCI) HDB Tirofiban, and downstream abciximab. We evaluated the effects of the three drug regimens on tissue-level perfusion using the corrected Thrombolysis In Myocardial Infarction (TIMI) frame count, the TIMI myocardial perfusion grade (TMPG), and intracoronary myocardial contrast echocardiography (MCE) before and immediately after PCI and after cardiac troponin I (cTnI). Results The TMPG 0/1 perfusion was significantly less frequent with upstream Tirofiban compared with HDB Tirofiban and abciximab both before (28.1% vs. 66.7% vs. 71%, respectively; p = 0.0009) and after PCI (6.2% vs. 20% vs. 35.5%, respectively; p = 0.015). Upstream Tirofiban was also associated with a significantly higher MCE score index (0.88 ± 0.18 vs. 0.77 ± 0.32 vs. 0.71 ± 0.30, respectively; p Conclusions Among high-risk non–ST-segment-elevation ACS patients treated with an early invasive strategy, upstream Tirofiban is associated with improved tissue-level perfusion and attenuated myocardial damage.
Donald L Lappe - One of the best experts on this subject based on the ideXlab platform.
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abstract 15074 safety and efficacy of peri procedural heparin plus short term infusion of Tirofiban versus bivalirudin in patients undergoing percutaneous coronary intervention results from the intermountain heart collaborative study
Circulation, 2016Co-Authors: Joseph B Muhlestein, Heidi T May, Tami L Bair, Jeffrey L Anderson, Brian Whisenant, Kirk U Knowlton, Donald L LappeAbstract:Introduction: A primary conflict in anticoagulation during percutaneous coronary intervention (PCI) is the simultaneous desire to prevent both thrombosis and bleeding. In modern PCI with standard dual oral antiplatelet therapy, the use of heparin + short (<6 hrs) infusions of glycoprotein IIb/IIIa inhibitors, or short infusions of bivalirudin alone, have been proposed as potentially superior alternatives to heparin plus more prolonged infusions. However, which strategy of short term anticoagulation during PCI is best is unknown. Therefore, we compared the safety and efficacy of heparin plus short term infusions of Tirofiban (S-Tirofiban) versus bivalirudin during elective or urgent PCI. Methods: From January 2013 to December 2015, patients who underwent successful PCI without cardiogenic shock and were anticoagulated using S-Tirofiban or bivalirudin were studied. TIMI major bleed (including any transfusion) at 30 days and death, nonfatal MI and urgent target vessel revascularization (UTVR) at 1 year were ascertained. Results: A total of 402 PCI patients receiving S-Tirofiban (age=64±13 yrs, males=75%, diabetes = 39%, smokers=26%, acute coronary syndrome presentation (ACS) = 77%) and 455 patients receiving bivalirudin, (age=65±13 yrs, males=71%, diabetes = 42%, smokers=26%, ACS=79%) were included. TIMI major bleed was 1.2% and 3.1% for S-Tirofiban and bivalirudin respectively. Adverse events at 1 year were death (3.4% and 5.5%), MI (2.9% and 3.0%), UTVR (2.0% and 1.5%) for S-Tirofiban and bivalirudin respectively. See table for multivariable results. Conclusion: During PCI, when comparing the efficacy of S- Tirofiban versus bivalirudin, no significant differences for 30 day TIMI major bleeding or 1 year death, MI or UTVR were identified. Although trends towards reductions in both TIMI major bleeding and death were observed with the use of S-Tirofiban, due to the generally low incidence of any adverse events, no statistical significance was reached. ![][1] [1]: /embed/graphic-1.gif
Marco Valgimigli - One of the best experts on this subject based on the ideXlab platform.
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phosphate or citrate buffered Tirofiban versus unfractionated heparin and its impact on thrombocytopenia and clinical outcomes in patients with acute coronary syndrome a post hoc analysis from the prism trial
Jacc-cardiovascular Interventions, 2016Co-Authors: Marianna Adamo, Sara Ariotti, F Costa, Salvatore Curello, Aris Moschovitis, Ton De Vries, Harvey D White, Stephan Windecker, Marco ValgimigliAbstract:Abstract Objectives The aim of this study was to investigate whether the 2 Tirofiban formulations tested in the early and late phases of the PRISM (Platelet Receptor Inhibitor in Ischemic Syndrome Management) trial might differ with respect to risk for thrombocytopenia and clinical outcomes compared with unfractionated heparin (UFH). Background Citrate-buffered Tirofiban is currently marketed as brand-name drug. However, Tirofiban has recently been promoted in some countries as a generic drug with different formulations, such as phosphate-buffered product. Methods In the PRISM trial 3,232 patients were randomly assigned to receive Tirofiban or UFH. In the early phase, 879 patients were allocated to phosphate-buffered Tirofiban and 874 patients to UFH group. After a protocol amendment due to a study drug instability report, citrate-buffered Tirofiban replaced the phosphate-buffered formulation. Therefore, in the late phase, 737 and 742 patients were treated with citrate-buffered Tirofiban and UFH, respectively. Results The relative risk for thrombocytopenia (nadir Conclusions Phosphate-buffered Tirofiban, currently marketed as a generic drug, is associated with a higher rate of thrombocytopenia with a potentially increased risk for adverse clinical outcomes compared with citrate-buffered Tirofiban.
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Tirofiban as adjunctive therapy for acute coronary syndromes and percutaneous coronary intervention a meta analysis of randomized trials
European Heart Journal, 2010Co-Authors: Marco Valgimigli, Christian W. Hamm, Giuseppe Biondizoccai, Matteo Tebaldi, Arnoud W J Van T Hof, Gianluca Campo, Jurrien Ten M Berg, Leonardo Bolognese, Francesco Saia, Gian Battista DanziAbstract:Aims To perform a thorough and updated systematic review of randomized clinical trials comparing Tirofiban vs. placebo or vs. abciximab. Methods and results We searched for randomized trials comparing Tirofiban vs. placebo or any active control. Odds ratios (OR) were computed from individual studies and pooled with random-effect methods. Thirty-one studies were identified involving 20 006 patients (12 874 comparing Tirofiban vs. heparin plus placebo or bivalirudin alone, and 7132 vs. abciximab). When compared with placebo, Tirofiban was associated at 30 days with a significant reduction in mortality [OR = 0.68 (0.54–0.86); P = 0.001] and death or myocardial infarction (MI) [OR = 0.69 (0.58–0.81); P < 0.001]. The treatment benefit persisted at follow-up but came at an increased risk of minor bleedings [OR = 1.42 (1.13, 1.79), P = 0.002] or thrombocytopenia. When compared with abciximab, mortality at 30 days did not differ [OR = 0.90 (0.53, 1.54); P = 0.70], but in the overall group Tirofiban trended to increase the composite of death or MI [OR = 1.18 (0.96, 1.45); P = 0.11]. No such trend persisted at medium-term follow-up or when appraising studies testing Tirofiban at 25 µg/kg bolus regimen. Conclusion Tirofiban administration reduces mortality, the composite of death or MI and increases minor bleedings when compared with placebo. An early ischaemic hazard disfavouring Tirofiban was noted when compared with abciximab in studies based on 10 but not 25 µg/kg Tirofiban bolus regimen.
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Defining the Role of Platelet Glycoprotein Receptor Inhibitors in STEMI
Drugs, 2009Co-Authors: Arnoud W. J. Hof, Marco ValgimigliAbstract:Tirofiban is a small molecule, nonpeptide tyrosine derivative. Although similar to abciximab in that it has a high specificity and affinity for the glycoprotein (GP) IIb/IIIa receptor, Tirofiban dissociates from the GP IIb/IIIa receptor more rapidly than abciximab. Additionally, the action of Tirofiban is reversed within hours after completion of the infusion, whereas abciximab binds irreversibly resulting in a considerably longer effect. The efficacy of Tirofiban in ST-segment elevation myocardial infarction (STEMI) has been demonstrated when administered in patients being managed with primary percutaneous coronary intervention (PCI). These trials primarily studied Tirofiban utilizing the high-dose bolus regimen (25 μg/kg bolus followed by a maintenance infusion of 0.15 mg/kg/min for 18–24 hours). The On-TIME (Ongoing Tirofiban in Myocardial Infarction Evaluation) 2 trial assessed early administration of the high-dose bolus regimen of Tirofiban either at the referral centre or in the ambulance, in patients being transferred to a primary PCI centre. Early use of Tirofiban resulted in both a significant increase in the rate of complete resolution of ST-segment deviation pre- and post-PCI, and improvement in clinical outcomes at 30 days. Moreover, the multi-factorial MULTISTRATEGY (Multicentre Evaluation of Single High-Dose Bolus Tirofiban vs Abciximab With Sirolimus-Eluting Stent or Bare Metal Stent in Acute Myocardial Infarction) trial, which compared the high-dose bolus regimen of Tirofiban with standard dose administration of abciximab administered immediately prior to PCI, revealed similar effects on myocardial perfusion, ST-segment elevation recovery and clinical outcomes between the two agents, and confirmed the safety of Tirofiban when used in combination with drug-eluting stents in patients with STEMI undergoing primary PCI. These studies showed Tirofiban to be a well tolerated and effective GP IIb/IIIa inhibitor. On the basis of the demonstrated benefits of the high-dose bolus regimen, Tirofiban may be considered useful in the management of patients with STEMI.
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Defining the role of platelet glycoprotein receptor inhibitors in STEMI: focus on Tirofiban.
Drugs, 2009Co-Authors: Arnoud W J Van T Hof, Marco ValgimigliAbstract:Tirofiban is a small molecule, nonpeptide tyrosine derivative. Although similar to abciximab in that it has a high specificity and affinity for the glycoprotein (GP) IIb/IIIa receptor, Tirofiban dissociates from the GP IIb/IIIa receptor more rapidly than abciximab. Additionally, the action of Tirofiban is reversed within hours after completion of the infusion, whereas abciximab binds irreversibly resulting in a considerably longer effect.
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the additive value of Tirofiban administered with the high dose bolus in the prevention of ischemic complications during high risk coronary angioplasty the advance trial
Journal of the American College of Cardiology, 2004Co-Authors: Marco Valgimigli, Gianfranco Percoco, Dario Barbieri, Fabrizio Ferrari, Gabriele Guardigli, Giovanni Parrinello, Olga Soukhomovskaia, Roberto FerrariAbstract:Abstract Objectives We sought to determine the safety and efficacy of high-dose bolus (HDB) Tirofiban in high-risk patients undergoing percutaneous coronary intervention (PCI). Background The use of HDB Tirofiban in the catheterization laboratory is controversial. In particular, in patients with acute coronary syndromes undergoing PCI, there is no evidence that Tirofiban administered in the catheterization laboratory is superior to heparin alone. This finding probably reflects the suboptimal platelet inhibition when Tirofiban is employed at RESTORE (Randomized Efficacy Study of Tirofiban for Outcomes and Restenosis) regimen. Methods A total of 202 patients (mean age 69 ± 8 years; 137 males [68%]) undergoing high-risk PCI, pretreated with thienopyridines, were consecutively randomized to HDB Tirofiban (25 μg/kg/3 min, and infusion of 0.15 μg/kg/min for 24 to 48 h) or placebo immediately before the procedure and then followed for a median time of 185 days (range 45 to 324 days) for the occurrence of the primary composite end point of death, myocardial infarction, target vessel revascularization (TVR), and bailout use of glycoprotein (GP) IIb/IIIa inhibitors. Results The cumulative incidence of the primary end point was 35% and 20% in placebo and HDB Tirofiban groups, respectively (hazard ratio 0.51, 95% confidence interval 0.29 to 0.88; p = 0.01). This difference was mainly due to the reduction of myocardial infarction and bailout use of GP IIb/IIIa inhibitors, with no significant effect on TVR or death. The safety profile did not differ between Tirofiban and placebo. Conclusions The use of Tirofiban, when administered at HDB, is safe and significantly reduces the incidence of ischemic/thrombotic complications during high-risk PCI.
David J Moliterno - One of the best experts on this subject based on the ideXlab platform.
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a randomized two by two comparison of high dose bolus Tirofiban versus abciximab and unfractionated heparin versus bivalirudin during percutaneous coronary revascularization and stent placement the Tirofiban evaluation of novel dosing versus abcixima
Catheterization and Cardiovascular Interventions, 2011Co-Authors: David J MoliternoAbstract:Background: In the absence of high-dose thienopyridines, placebo-controlled trials have demonstrated a reduction in ischemic events with intravenous glycoprotein IIb/IIIa antagonists during percutaneous coronary intervention (PCI). One head-to-head trial comparing abciximab and Tirofiban among PCI patients found Tirofiban to be inferior, and laboratory evidence confirmed that the bolus dose of Tirofiban tested in that trial to be less effective than abciximab. Whether a higher bolus dose of Tirofiban would be as efficacious as abciximab during PCI is uncertain. Methods and Results: Patients undergoing PCI were randomized equally to abciximab or to Tirofiban, given as high-dose bolus (25 μg/kg) plus 12-hr infusion (0.15 μg/kg/min). All patients received aspirin and clopidogrel and were additionally randomized to unfractionated heparin or bivalirudin. Approximately 8,000 patients were to be studied, but after 383 were enrolled, the study sponsor discontinued the trial for financial reasons. The primary endpoint of 30-day death, myocardial infarction, or urgent target vessel revascularization occurred in 8.8% of patients randomized to abciximab and 6.9% of those randomized to Tirofiban. The respective rates of major bleeding were 1.5 and 1.6%. Additionally, the primary endpoint occurred in 8.1% of patients randomized to unfractionated heparin and 7.6% of those randomized to bivalirudin. The respective rates of major bleeding were 2.5% and 0.5%. Conclusion: With limited assessment, this direct comparison of high-dose bolus Tirofiban versus abciximab produced encouraging results and suggests that further study of this Tirofiban dose regimen is warranted. The limited assessments comparing heparin and bivalirudin are consistent with prior observations. © 2010 Wiley-Liss, Inc.
Leonardo Olognese - One of the best experts on this subject based on the ideXlab platform.
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randomized comparison of upstream Tirofiban versus downstream high bolus dose Tirofiban or abciximab on tissue level perfusion and troponin release in high risk acute coronary syndromes treated with percutaneous coronary interventions the everest tri
Journal of the American College of Cardiology, 2006Co-Authors: Leonardo Olognese, Giovanni Falsini, Francesco Liistro, Paolo Angioli, Kenneth Ducci, Tamara Taddei, Roberto Tarducci, Franco Cosmi, Silvia Aldassarre, Antonio UraliAbstract:Objectives We aimed to compare the effects of upstream Tirofiban versus downstream high-dose bolus (HDB) Tirofiban and abciximab on tissue level perfusion and troponin I release in high-risk non–ST-segment elevation acute coronary syndrome (ACS) patients treated with percutaneous coronary intervention (PCI). Background Optimal timing and dosage of glycoprotein IIb/IIIa inhibitors for ACS remain to be explored. Methods We randomized 93 high-risk ACS patients undergoing PCI to receive upstream (in the coronary care unit) Tirofiban, downstream (just prior to PCI) HDB Tirofiban, and downstream abciximab. We evaluated the effects of the three drug regimens on tissue-level perfusion using the corrected Thrombolysis In Myocardial Infarction (TIMI) frame count, the TIMI myocardial perfusion grade (TMPG), and intracoronary myocardial contrast echocardiography (MCE) before and immediately after PCI and after cardiac troponin I (cTnI). Results The TMPG 0/1 perfusion was significantly less frequent with upstream Tirofiban compared with HDB Tirofiban and abciximab both before (28.1% vs. 66.7% vs. 71%, respectively; p = 0.0009) and after PCI (6.2% vs. 20% vs. 35.5%, respectively; p = 0.015). Upstream Tirofiban was also associated with a significantly higher MCE score index (0.88 ± 0.18 vs. 0.77 ± 0.32 vs. 0.71 ± 0.30, respectively; p Conclusions Among high-risk non–ST-segment-elevation ACS patients treated with an early invasive strategy, upstream Tirofiban is associated with improved tissue-level perfusion and attenuated myocardial damage.
