Effects and safety of different doses of tirofiban in treatment of acute coronary syndrome with diabetes in the elderly

Shi Xiaoling; Qin Jingmei; Liu Ping

doi:10.3760/cma.j.issn.1673-4777.2014.11.003

Abstract：Objective To evaluate the clinical effects and safety of differrent doses of tirofiban in the treatment of acute coronary syndromes (ACS) combined with diabetes in over 75 years old patients.Methods Ninety-two cases were randomly divided into tirofiban routine dose group (n =32),half dose group (n =30)and routine treatment group(n =30).Tirofiban routine dose group was treated with tirofiban based on standard treatment.Half dose group was treated with half dose of tirofiban.Blood was collected (immediately divided into groups and after given tirofiban for 24 h)and the ability of blood clotting and fibrinolysis with thrombelastography was recorded.The major adverse cardiac events and major bleeding adverse reactions of three groups were observed before and after treatment.Results ①The total effective rate of angina remision was higher in routine and half dose group than in routine treatment group[96.9％ (31/32),96.7％ (29/30) vs 76.7％ (23/30)] ;there was no statistical significance between routine and half dose grouP(x2 =0.45,P ＞0.05).②The major adverse cardiac events were lower in routine and half dose group than in routine treatment group [9.4％ (3/32),6.7％ (2/30) vs 23.3 ％ (7/30),P ＜ 0.05].There was no statistical significance between routine and half dose group(x2 =0.01,P ＞ 0.05).③There was no severe hemorrage in three groups.The major bleeding adverse reactions were higher in routine and half dose group than in routine treatment group[40.6％ (13/32),10.0％ (3/30) vs 6.7％ (2/30),P ＜ 0.05].There was statistically significant difference between routine and half dose group (x2 =6.07,P ＜ 0.05).④24 h after giving tirofiban,reaction time and coagulation time were prolonged; forming speed of thrombin slowed down; stability of blood clots and complex index decreased in three groups[tirofiban routine dose group:(6.7 ± 2.5) min vs (4.4 ± 1.7) min,(4.1 ± 1.4) min vs (1.0 ± 0.7) min,(34 ± 22) mm vs (87 ± 36) mm,(-4.81 ± 2.07) vs (0.87 ± 0.18) ; tirofiban routine half dose group:(10.0 ± 3.3) min vs (5.2 ±1.8)min,(3.8± 1.5)min vs (1.8 ±0.6)min,(50 ±23)mm vs (75 ±27)mm,(-4.01 ±1.52) vs (1.39± 0.23) ; routine treatment group:(7.7 ± 3.1) min vs (5.8 ± 2.6) min,(4.0 ± 1.9) min vs (1.6 ± 0.4) min,(45 ± 19) mm vs (68 ± 24) mm,(-3.65 ± 1.07) vs (2.00 ± 0.96)] (P ＜ 0.05).The number of maximum amplitude and coagulation index was lower in routine and half dose group than in routine treatment group(P ＜0.05).There was a statistically significant difference between routine dose and routine treatment group regarding the coagulation time (P ＜ 0.05).Conclusion On the basis of the conventional antiplatelet and anticoagulant drugs,half dose of tirofiban is relatively safe and effective in the treatment of ACS combined with diabetes in over 75 years old patients.