EXAMPLES
Tirofiban, eptifibatide
MECHANISM OF ACTION
a non-peptide antagonist that prevents fibrinogen from binding to the glycoprotein IIb/IIIa receptor, thus blocking platelet aggregation.
INDICATIONS
- Unstable angina/non-ST elevation MI (given with aspirin and heparin).
- Reduce the immediate risk of vascular occlusion in patients undergoing percutaneous coronary intervention
CAUTIONS AND CONTRA-INDICATIONS
- Active bleeding.
- Major surgery or trauma in the past 6 weeks.
- Ischaemic stroke within 30 days or any history of haemorrhagic stroke.
- Intracranial pathology (e.g. aneurysm, neoplasm or AV malformation).
- Severe hypertension.
- Deranged clotting or thrombocytopenia
SIDE-EFFECTS
- Bleeding.
- Nausea.
- Headaches.
- Fever.
- Reversible thrombocytopenia
METABOLISM AND HALF-LIFE
- t½ of tirofiban is 90min.
- Excreted largely unchanged in the urine.
MONITORING
- Continuous cardiac monitoring.
- Monitor clinically for signs of bleeding.
DRUG INTERACTIONS
- Risk of haemorrhage is increased with heparin and antiplatelet drugs
IMPORTANT POINTS
- Treatment should be for a minimum of 48 h a maximum of 108h if the patient remains unstable with a view to in-patient angiography and potential revascularisation as soon as possible