Key result
Ultrafiltration effectively eliminates therapeutic tirofiban levels in an in vitro CPB model across filter systems.
Why the study?
Extracorporeal elimination methods are needed to prevent excessive hemorrhage from prolonged tirofiban activity in patients with renal failure undergoing cardiac surgery.
Does zero-balanced ultrafiltration effectively eliminate large concentrations of tirofiban in an in vitro cardiopulmonary bypass model?
Does zero-balanced ultrafiltration effectively eliminate large concentrations of tirofiban in an in vitro cardiopulmonary bypass model?
Ultrafiltration effectively eliminates high therapeutic levels of tirofiban in an in vitro cardiopulmonary bypass model, suggesting a potential management strategy for cardiac surgery patients with impaired renal function.
Tirofiban clearance by ultrafiltration in CPB warrants clinical awareness; in vitro data leave open effects on bleeding and dosing.
In Brief The short-acting platelet glycoprotein IIb/IIIa antagonist tirofiban is beneficial when used in the context of cardiac surgery. Tirofiban has an elimination half-life of 2 h. Renal failure prolongs the half-life and continues inhibition of platelet aggregation refractory to transfusions of platelets. Extracorporeal elimination is necessary to prevent excessive hemorrhage in this condition. We assessed the elimination of tirofiban by hemofiltration in an in vitro model of cardiopulmonary bypass (CPB). Two hemofilters and one plasmapheresis filter were assessed. Three separate filters of each type were tested serially. The CPB circuit was primed with a total volume of 1000 mL. Tirofiban was added to a calculated concentration of 200 ng/mL. Portions of 50 mL of filtrate were retrieved from the dialyzer, and equal amounts of fluid were substituted in the circuit. After each filtration, the tirofiban blood level was analyzed. The procedure was repeated 16 times. Peak tirofiban concentrations ranged from 160 to 260 ng/mL. The elimination of tirofiban followed an exponential decay curve with fast clearance of the large therapeutic concentrations of 250 to 50 ng/mL. The subsidence coefficient b revealed no significant differences in elimination between the filter systems. These data suggest that ultrafiltration is an effective means for extracorporeal elimination of therapeutic levels of tirofiban. IMPLICATIONS: Our data provide evidence that ultrafiltration is an effective method for extracorporeal elimination of high therapeutic levels of tirofiban. These results are of particular interest for the management of patients with impaired renal function or a high risk of developing perioperative renal failure who undergo cardiac surgery with the administration of tirofiban in the perioperative period.
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Koster et al. (2004) studied Cardiac surgery with impaired renal function (in vitro model). Zero-balanced ultrafiltration was evaluated on Elimination of tirofiban. In an in vitro model of cardiopulmonary bypass, ultrafiltration effectively eliminated large therapeutic concentrations of tirofiban (250 to 50 ng/mL) with no significant differences between filter systems.
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