Tirofiban 1996-2001

Aggrastat Trials - Free PowerPoint Slides
http://www.clinicaltrialresults.org/ua/aggrastat/aggrastat_home.htm  

CyberSession
Getting it right from the start: unlocking the ER and CCU
http://www.theheart.org/index.cfm?doc_id=21642 
Drs Christopher P Cannon and Eric J Topol review the TACTICS-TIMI 18 and TARGET data and discuss the implications for clinical practice

TCT 2001 Expert Presentations 

Comparison of two platelet glycoprotein IIb/IIIa inhibitors, tirofiban and abciximab, for the prevention of ischemic events with percutaneous coronary revascularization
Topol EJ, et al. for the TARGET Investigators
N Engl J Med 2001;344:1888-94
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11419425 
Comment-1  

Upstream use of tirofiban in patients admitted for an acute coronary syndrome in hospitals with or without facilities for invasive management. PRISM-PLUS Investigators
Theroux P, et al.
Am J Cardiol 2001;87:375-80
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=11179517
Upstream treatment with tirofiban plus heparin confers clinical benefits in unstable angina and/or non-ST-segment elevation infarction patients regardless of whether initial presentation is to a hospital without catheterization facilities or to a hospital with such facilities.

Late-Breaking Clinical Trial 
TARGET Trial (Do Tirofiban And ReoproGive Similar Efficacy Outcomes)
  Topol E -  Presented at AHA 2000 Meeting
The first head-to-head trial designed to show comparability between two GPIIb/IIIa inhibitors (abciximab and tirofiban) revealed 30-day death/MI/urgent TVR benefits for abciximab. The conclusion that the trial results establish abciximab as the PCI "reference standard IIb/IIIa inhibitor" by TARGET lead investigator Eric Topol, M.D., was challenged by another expert, Gregg Stone, M.D., based on stronger tirofiban results at US sites and cost-effectiveness considerations.

Click here to view the full article.

Click here or here to view the slides.  

Click here for new additional results (PowerPoint slides)

Late-Breaking Clinical Trial 
TACTICS-TIMI 18 Trial (Treat Angina with Aggrastat® and determine Cost of Therapy)
  Cannon - Presented at AHA 2000
  Click here  to view the slides
GP IIb/IIIa inhibitors and stents may make early invasive care the choice for ACS - TACTICS-TIMI 18 is only the latest of many randomized trials to test whether routine invasive management or a more conservative, ischemia-driven approach to cardiac catheterization yields better outcomes for patients with unstable angina or non-ST-elevation MI. But it's probably the first to be performed in the era of widespread coronary stenting with adjuvant GP IIb/IIIa inhibition. This time, early invasive care that included tirofiban and, as needed, stenting, showed clear and significant survival advantages, with reductions in cardiac events, at both 30 days and at six months. According to TIMI investigator Christopher Cannon, MD, "This should change the clinical management of patients with unstable angina, with broader use of an early invasive strategy incorporating GP IIb/IIIa inhibition."
Click here to view the full article.

TARGET and TACTICS
Two quite different trials - TACTICS and TARGET - reported at this year's AHA help elucidate the role of these agents. Two well-known commentators, Drs Eric Topol and Rob Califf, had good words for both studies and intriguing ideas where they might lead. 
The audio and slides are posted at: http://www.theheart.org/index.cfm?doc_id=19631

Timing of coronary stent thrombosis in patients treated with prophylactic tirofiban 
  Assali AR et al. 
  J Invasive Cardiol 2000;12:460-3
  http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=0010973371
  Click here to view the slide
Prophylactic tirofiban treatment delays the time to stent thrombosis after successful coronary artery stent implantation for more than two days. Patients at high risk for stent thrombosis treated with short-acting glycoprotein IIb/IIIa platelet receptor inhibitors may warrant close follow-up during the first week after stenting

Six-month angiographic and clinical follow-up of patients prospectively randomized to receive either tirofiban or placebo during angioplasty in the RESTORE trial. Randomized Efficacy Study of Tirofiban for Outcomes and Restenosis
Gibson CM, et al.
J Am Coll Cardiol 1998;32:28-34.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=9669245 

Inhibition of the platelet glycoprotein IIb/IIIa receptor with tirofiban in unstable angina and non-Q-wave myocardial infarction. Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) Study Investigators
N Engl J Med 1998;338:1488-97.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=9599103 

Effects of platelet glycoprotein IIb/IIIa blockade with tirofiban on adverse cardiac events in patients with unstable angina or acute myocardial infarction undergoing coronary angioplasty. The RESTORE Investigators. Randomized Efficacy Study of Tirofiban for Outcomes and REstenosis
Circulation 1997;96:1445-53.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=9315530 

Randomized, double-blind, placebo-controlled dose-ranging study of tirofiban (MK-383) platelet IIb/IIIa blockade in high risk patients undergoing coronary angioplasty
Kereiakes DJ, et al.
J Am Coll Cardiol 1996;27:536-42.
http://www.ncbi.nlm.nih.gov/htbin-post/Entrez/query?db=m&form=6&dopt=r&uid=8606262