Tirofiban as adjunctive therapy for acute coronary syndromes and percutaneous coronary intervention: A meta-analysis of randomized trials

Marco Valgimigli, Giuseppe Biondi-Zoccai, Matteo Tebaldi, Arnoud W.J. Van 'T Hof, Gianluca Campo, Christian Hamm, Jurriën Ten Berg, Leonardo Bolognese, Francesco Saia, Gian Battista Danzi, Carlo Briguori, Ertan Okmen, Spencer B. King, David J. Moliterno, Eric J. Topol

Research output: Contribution to journalArticlepeer-review

110 Scopus citations

Abstract

AimsTo perform a thorough and updated systematic review of randomized clinical trials comparing tirofiban vs. placebo or vs. abciximab.Methods and resultsWe searched for randomized trials comparing tirofiban vs. placebo or any active control. Odds ratios (OR) were computed from individual studies and pooled with random-effect methods. Thirty-one studies were identified involving 20 006 patients (12 874 comparing tirofiban vs. heparin plus placebo or bivalirudin alone, and 7132 vs. abciximab). When compared with placebo, tirofiban was associated at 30 days with a significant reduction in mortality [OR = 0.68 (0.54-0.86); P = 0.001] and death or myocardial infarction (MI) [OR = 0.69 (0.58-0.81); P < 0.001]. The treatment benefit persisted at follow-up but came at an increased risk of minor bleedings [OR = 1.42 (1.13, 1.79), P = 0.002] or thrombocytopenia. When compared with abciximab, mortality at 30 days did not differ [OR = 0.90 (0.53, 1.54); P = 0.70], but in the overall group tirofiban trended to increase the composite of death or MI [OR = 1.18 (0.96, 1.45); P = 0.11]. No such trend persisted at medium-term follow-up or when appraising studies testing tirofiban at 25 g/kg bolus regimen. ConclusionTirofiban administration reduces mortality, the composite of death or MI and increases minor bleedings when compared with placebo. An early ischaemic hazard disfavouring tirofiban was noted when compared with abciximab in studies based on 10 but not 25 g/kg tirofiban bolus regimen.

Original languageEnglish
Pages (from-to)35-49
Number of pages15
JournalEuropean Heart Journal
Volume31
Issue number1
DOIs
StatePublished - Jan 2010

Bibliographical note

Funding Information:
Conflicts of interest: M.V. has consulted for Iroko, Eli Lilly and the Medicines Company, has lectured for Iroko, Glaxo SmithKline and received grant support from Iroko and Eli Lilly. G.B.-Z. has consulted for Cordis and The Medicines Company, has lectured for Bristol-Myers Squibb and sanofi-aventis, and has received grant support from Glaxo SmithKline.

Funding Information:
This work was supported by the University of Ferrara, Italy.

Keywords

  • Abciximab
  • Glycoprotein IIb/IIIa inhibitors
  • Percutaneous coronary intervention
  • Systematic review
  • Tirofiban

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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