tirofiban: clinical use

Prescribing considerations

• Hospital use by specialists experienced in acute coronary syndrome management.
• Assess current and recent bleeding, stroke history, surgery or trauma, blood pressure, renal and hepatic function, vascular access and concomitant treatments affecting haemostasis.
• Renal impairment reduces tirofiban clearance; check renal function and follow product-specific prescribing instructions.
• Minimise intramuscular injections and unnecessary invasive procedures; use compressible vascular access sites where possible.

Contraindications and cautions

• Previous thrombocytopenia caused by a GP IIb/IIIa receptor antagonist or hypersensitivity to the product.
• Recent stroke or any previous haemorrhagic stroke; known intracranial neoplasm, arteriovenous malformation or aneurysm.
• Active or recent clinically relevant bleeding, malignant hypertension, or recent major trauma or surgery.
• Thrombocytopenia, platelet-function disorders, significant clotting disturbance or severe liver failure.

Monitoring

• Platelet count, haemoglobin and haematocrit before and during treatment.
• Access sites, mucosal surfaces, urine and stool for bleeding.
• APTT during concurrent unfractionated heparin treatment and ACT where relevant to coronary intervention.
• Repeat platelet counts promptly if thrombocytopenia is suspected, with earlier checks after re-exposure to a GP IIb/IIIa inhibitor.

Clinical pharmacology

A reversible, non-peptide GP IIb/IIIa antagonist with limited metabolism and substantial renal and biliary elimination. Platelet function generally returns towards baseline after treatment stops; clearance is reduced in renal impairment.

Formulation and product differences

• The selected product is a clear, colourless, ready-to-use intravenous solution supplied in a PVC-free infusion bag.
• Inspect the solution and bag before use; do not add supplementary medicines or connect plastic containers in series.
• The infusion bag has substantial sodium content, which may matter when sodium restriction is clinically important.