EXAMPLES  Tirofiban, eptifibatide

MECHANISM OF ACTION  a non-peptide antagonist that prevents fibrinogen from binding to the glycoprotein IIb/IIIa receptor, thus blocking platelet aggregation.

INDICATIONS

• Unstable angina/non-ST elevation MI (given with aspirin and heparin).
• Reduce the immediate risk of vascular occlusion in patients undergoing percutaneous coronary intervention

CAUTIONS AND CONTRA-INDICATIONS

• Active bleeding.
• Major surgery or trauma in the past 6 weeks.
• Ischaemic stroke within 30 days or any history of haemorrhagic stroke.
• Intracranial pathology (e.g. aneurysm, neoplasm or AV malformation).
• Severe hypertension.
• Deranged clotting or thrombocytopenia

SIDE-EFFECTS 

• Bleeding.
• Nausea.
• Headaches.
• Fever.
• Reversible thrombocytopenia

METABOLISM AND HALF-LIFE 

• t½ of tirofiban is 90min.
• Excreted largely unchanged in the urine.

MONITORING 

• Continuous cardiac monitoring.
• Monitor clinically for signs of bleeding.

DRUG INTERACTIONS

• Risk of haemorrhage is increased with heparin and antiplatelet drugs

IMPORTANT POINTS

• Treatment should be for a minimum of 48 h a maximum of 108h if the patient remains unstable with a view to in-patient angiography and potential revascularisation as soon as possible