High-dose tirofiban during PCI is associated with significant reduction in all-cause mortality

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A meta-analysis of 41 randomized clinical trials found that patients who received high-dose bolus tirofiban (Aggrastat, Medicure, Inc.) during PCI had a significant reduction in all-cause mortality compared with those who received eptifibatide or heparin.

There were no significant differences between the anticoagulation strategies with regards to MI, major bleeding or major adverse cardiovascular events.

Lead researcher Michael J. Lipinski, MD, PhD, of the MedStar Heart and Vascular Institute in Washington, DC,  presented results of the study at the Cardiovascular Research Technologies conference in Washington, DC. The findings were simultaneously published online in the  Journal of the American College of Cardiology: Cardiovascular Interventions on Feb. 23.

The researchers searched the MEDLINE and CENTRAL databases for randomized studies that compared high-dose bolus tirofiban, abciximab, eptifibatide, heparin with provisional glycoprotein inhibitors (GPI) and bivalirudin with provisional GPI. They performed a mixed treatment comparison model to compare the anticoagulation strategies.

The 41 trials included 38,645 patients: 2,654 received high-dose bolus tirofiban, 6,752 received abciximab, 1,669 received eptifibatide, 16,500 received heparin and 11,070 received bivalirudin.

The mean age was 64 years old, while 75 percent of patients were males, 91 percent were treated with stenting, 71 percent received clopidogrel, 46 percent presented with STEMI and 74 percent had acute coronary syndrome.

The researchers noted that abciximab was associated with a greater risk of thrombocytopenia, while bivalirudin was associated with fewer major and minor bleeding events compared with the other anticoagulation treatments.