Key result
For patients with severe renal impairment, a 25 µg/kg bolus followed by a 0.10 µg/kg/min infusion of tirofiban produced a plasma concentration-time profile similar to the standard high-dose bolus regimen in normal renal function.
Why the study?
What is the appropriate dosage of tirofiban to achieve a similar plasma concentration-time profile in patients with severe renal impairment compared to patients with normal renal function receiving a high-dose bolus regimen?
What is the appropriate dosage of tirofiban to achieve a similar plasma concentration-time profile in patients with severe renal impairment compared to patients with normal renal function receiving a high-dose bolus regimen?
Pharmacokinetic modeling suggests that patients with severe renal impairment should receive a full 25 µg/kg bolus of tirofiban followed by a reduced maintenance infusion of 0.10 µg/kg/min, challenging previous recommendations to reduce the entire dosage by 50%.
Supports adjusted tirofiban dosing in severe renal impairment; hypothesis-generating and requires randomized outcome confirmation.
For the treatment of patients with acute coronary syndromes in the catheterization laboratory, a high-dose bolus (HDB) regimen of tirofiban (25 µg/kg bolus, followed by an infusion of 0.15 µg/kg/min) leads to a consistent and rapid inhibition of platelet aggregation during the first hour after initiation of therapy. The objective of the present study was to use pharmacokinetic modeling to identify an appropriate dosage of tirofiban that would produce a plasma concentration-time profile in patients with severe renal impairment (creatinine clearance<30 ml/min) as similar as possible to that of the HDB regimen in patients with normal renal function. For patients with severe renal impairment, previous recommendations have been to reduce the dosage by 50%. Pharmacokinetic modeling was performed with the following sets of data: the plasma concentrations of tirofiban from patients with normal renal function who were treated with the HDB regimen of tirofiban and the plasma concentrations of tirofiban from patients with severe renal impairment who were treated with a 0.1 µg/kg/min infusion of tirofiban for 1 h. In conclusion, for patients with severe renal impairment, a 25 µg/kg bolus, followed by a 0.10 µg/kg/min maintenance infusion of tirofiban produced a plasma concentration-time profile similar to that observed with the HDB regimen of tirofiban in patients with normal renal function.
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Lakings et al. (2012) studied Acute coronary syndromes with severe renal impairment. Tirofiban vs. High-dose bolus regimen (25 µg/kg bolus, followed by 0.15 µg/kg/min infusion) in patients with normal renal function was evaluated on Plasma concentration-time profile. For patients with severe renal impairment, a 25 µg/kg bolus followed by a 0.10 µg/kg/min infusion of tirofiban produced a plasma concentration-time profile similar to the standard high-dose bolus regimen in normal renal function.
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