Glycoprotein IIb/IIIa inhibitors in STEMI

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Tirofiban

Mechanism of action:
- GP IIb/IIIa Receptor Antagonists
Dosage:
- (double bolus): 180-mcg/kg IV bolus, then 2 mcg/kg/min; a second 180-mcg/kg bolus is administered 10 min after the first bolus
- In patients with CrCl <50 mL/min, reduce infusion by 50%
- Avoid in patients on hemodialysis
PK:
- Onset of action: Within 1 minutes of bolus administration
- Elimination half-life: 2.5 hours
Adverse Effects:
- Dyspnea, hypotension, headache, bleeding
Clinical Pearls & Practical Considerations:
- It should be discontinued at least 2 hours prior to surgery or other invasive procedures.

Drug	Recommendation	LOE	COE
Abciximab	0.25-mg/kg IV bolus, then 0.125 mcg/kg/min (maximum 10 mcg/min) (No longer on the market in the US)	IIa	A
Tirofiban	(high-bolus dose): 25-mcg/kg IV bolus, then 0.15 mcg/kg/min ● In patients with CrCl <30 mL/min, reduce infusion by 50%	IIa	B
Eptifibatide	(double bolus): 180-mcg/kg IV bolus, then 2 mcg/kg/min; a second 180-mcg/kg bolus is administered 10 min after the first bolus •In patients with CrCl <50 mL/min, reduce infusion by 50% •Avoid in patients on hemodialysis	IIa	B
	Pre-catheterization laboratory administration of IV GP IIb/IIIa receptor antagonist	IIb	B
	Intracoronary abciximab 0.25-mg/kg bolus (No longer on the market in the US)	IIb	B

2013 ACCF/AHA guideline. Circulation. 2013 Jan 29;127(4):e362-425.