Benefits and Safety of Tirofiban Among Acute Coronary Syndrome Patients With Mild to Moderate Renal Insufficiency

• DOI: 10.1161/01.cir.0000016359.94919.16
• Publication Date: 2002-07-28T23:16:47Z
• Authors: James L. Januzzi; Steven M. Snapinn; Peter M. DiBattiste; Ik-Kyung Jang; Pierre Theroux
• Keywords: Tirofiban

Background — The role of glycoprotein IIb/IIIa receptor antagonists for the treatment patients with acute coronary syndrome and renal insufficiency remains undefined. Methods Results Patients from Platelet Receptor Inhibition in Ischemic Syndrome Management Limited by Unstable Signs Symptoms (PRISM-PLUS) trial were stratified creatinine clearance (CrCl) assessed respect to assignment tirofiban/heparin versus heparin alone risk adverse outcomes bleeding. severe (defined as a serum ≥2.5 mg/dL) excluded PRISM-PLUS whole. lowest CrCl (<30 mL/min) more likely present high-risk clinical features. Decreasing function was strongly associated outcome, increasing ischemic complications at all time points examined (all P <0.002). Irrespective CrCl, therapy tirofiban reduced odds composite end point death, myocardial infarction, or refractory ischemia 48 hours (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.46 1.0; =0.05), 7 days (OR, CI, 0.52 0.88; = 0.003), 30 0.78; 0.63 0.98; =0.03), 6 months 0.81; 0.68 =0.03). infarction/death also significantly decreased similar magnitude examined. There no evidence treatment-by-CrCl interaction. presence declining independently increased bleeding 1.57; <0.001 trend across categories), did tirofiban, but unexpected incremental due observed among categories. Conclusions Among mild-to-moderate PRISM-PLUS, well tolerated effective reducing complications.