Long term tirofiban infusion before percutaneous coronary intervention in patients with angiographically massive intracoronary thrombus

OBJECTIVE: To evaluate the impact of long term tirofiban infusion before percutaneous coronary intervention (PCI) on the angiographic results in the setting of visible intracoronary thrombus and compare this with conventional PCI performed without tirofiban.

METHODS: Out of 2835 PCI procedures performed in Gazi University Hospital, Ankara, Turkey between 1999 and 2006, 156 (5.5%) patients with massive thrombus in whom PCI were applied, were included in this retrospective study. Out of these 156 patients, 82 (53%) had PCI in the presence of angiographically apparent thrombus without tirofiban and named as group A. The remaining 74 (47%) received long term tirofiban infusion before PCI and were named as group B.

RESULTS: Although the baseline thrombolysis in myocardial infarction (TIMI) 0-2 flow was no different between the groups, it is significantly lower in group B compared to group A after the PCI (8.1% versus 23.2%, p=0.015). The decrease in thrombus burden in group B after tirofiban infusion was also statistically significant compared to pre-tirofiban levels (1.77 -/+ 1.05 versus 3.42 -/+ 0.76, p<0.001). Group B had better flow characteristics with a 91.9% TIMI 3 flow after PCI. Intervention was successful in the majority technically, however, no reflow was observed in 17 patients (20.7%) in group A and in 2 patients (2.7%) in group B (p<0.001). Major bleeding requiring transfusion was observed in both groups A (3 patients) and B (4 patients) due to gastrointestinal bleeding or access site hematomas (3.7% versus 5.4%, non significant).

CONCLUSION: Pre-PCI longterm tirofiban infusion strategy in thrombus containing lesions seems to be a safe and feasible approach in avoiding no re-flow and dissolving the massive thrombus.