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Cardiovascular Emergency Pregnancy: Avoid — no adequate safety data; seek specialist haematology/obstetrics advice

Tirofiban

Brand names: Aggrastat

Adult dose

Dose: 25 mcg/kg IV bolus over 3 minutes, then 0.15 mcg/kg/minute infusion
Route: IV
Frequency: Bolus then continuous infusion
Max: 0.15 mcg/kg/minute
High-dose bolus regimen (25 mcg/kg) recommended for STEMI or complex NSTEMI; continue for 12–24 hours after PCI. Use pre-diluted 50 mcg/mL solution.

Paediatric dose

Dose: Seek specialist opinion N/A/kg
Route: IV
Frequency: N/A
Max: N/A
Not established in paediatrics; seek specialist paediatric cardiology opinion

Dose adjustments

Renal

GFR under 30 mL/min: reduce infusion to 0.075 mcg/kg/minute (50% reduction); no bolus dose adjustment

Hepatic

No specific adjustment; use with caution in severe hepatic impairment due to coagulopathy risk

Paediatric weight-based calculator

Not established in paediatrics; seek specialist paediatric cardiology opinion

Clinical pearls

  • Mechanism: non-peptide GPIIb/IIIa receptor antagonist — blocks fibrinogen binding to platelet GPIIb/IIIa receptor, the final common pathway of platelet aggregation; rapidly reversible (4–8 hour half-life)
  • PRISM-PLUS trial: tirofiban + heparin vs heparin alone in NSTEMI — significant reduction in composite death/MI/refractory ischaemia; benefit greatest in high-risk patients (elevated troponin, TIMI risk score 4 or above)
  • ACUTE thrombocytopenia: check platelet count at 6 hours and 24 hours after starting — profound thrombocytopenia (below 50) occurs in 0.5%; stop immediately if platelets fall acutely
  • Upstream vs downstream use: current ESC guidelines favour downstream use (in catheterisation lab, not pre-hospital) — particularly for bailout situations such as large thrombus burden, no-reflow, or thrombotic complications during PCI
  • MHRA: licensed for NSTEMI and unstable angina — not licensed for STEMI (off-label); abciximab and eptifibatide are alternatives
  • Platelet function returns approximately 4–8 hours after stopping infusion — time-critical if emergency surgery required

Contraindications

  • Active bleeding or history of stroke within 30 days
  • Severe hypertension above 180/110 mmHg uncontrolled
  • Thrombocytopenia below 100 × 10⁹/L
  • Intracranial pathology
  • Recent major surgery or trauma within 6 weeks

Side effects

  • Bleeding (access site, GI, intracranial)
  • Thrombocytopenia — including severe acute within hours of first dose
  • Nausea
  • Fever
  • Bradycardia

Interactions

  • Anticoagulants — heparin, LMWH — additive bleeding; use together cautiously in ACS as per protocol
  • Other antiplatelets (aspirin + clopidogrel + tirofiban = triple antiplatelet — bleeding risk)
  • Thrombolytics (AVOID — major haemorrhage)

Monitoring

  • Platelet count at baseline, 6 hours, and 24 hours (acute thrombocytopenia monitoring)
  • Haemoglobin and haematocrit (bleeding)
  • APTT if concurrent heparin
  • ACT during PCI
  • Access site haemostasis

Reference: BNFc; BNF 90; ESC NSTE-ACS Guidelines 2020; PRISM-PLUS trial NEJM 1998;338(21):1488-1497; NICE NG185. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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