Tirofiban for myocardial infarction

Importance of the field: Inhibition of platelet aggregation plays a key role in treatment of coronary artery disease. Areas covered in this review: Studies on the effects of tirofiban in patients with either ST elevation or non-ST elevation myocardial infarction are reviewed. What the reader will gain: Tirofiban is a small-molecule glycoprotein IIb/IIIa receptor inhibitor. If discontinued, the action of tirofiban is faster reversed as abciximab. The dose varied between low (bolus of 0.4 mu g/kg administered over 30 min followed by an infusion of 0.10 mu g/kg/min), intermediate (bolus of 10 mu g/kg administered over 3 min followed by an infusion of 0.15 mu g/kg/min) and high (bolus of 25 mu g/kg administered over 3 min followed by an infusion of 0.15 mu g/kg/min). The high-dose administration especially may be beneficial in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI). There is no indication for tirofiban in patients treated with thrombolysis. Patients with non-ST elevation myocardial infarction requiring PCI are most likely to benefit from tirofiban if they have ongoing ischemia and/or dynamic ECG changes. The risk of serious bleeding with tirofiban is low and there is a very low risk of thrombocytopenia. Take home message: Use of tirofiban for myocardial infarction is effective and has an acceptable safety profile.