Use of Tirofiban as a bridge to cardiac surgery in patients under treatment with P2Y12 inhibitors

Introduction: tirofiban is a glycoprotein IIb/IIIa inhibitor with a proven use in certain acute coronary syndrome scenarios. Its safety and efficacy as a bridge to cardiac surgery, in view of the suspension of inhibitors P2Y12 in patients with recent angioplasty, is uncertain. Objective: to study the incidence of ischemic and hemorrhagic complications in patients requiring a tirofiban bridge prior to major cardiac surgery. Methods: we conducted an observational, prospective, single-center study, including inpatients with recent angioplasty who used tirofiban as a treatment prior to myocardial revascularization surgery, with and without associated valve replacement. We used an institution protocol for the infusion of tirofiban. We measured the incidence of myocardial infarction and bleeding (BARC) in the pre-treatment and in the postoperative period of cardiac surgery. Results: Our study included 50 middle-age (69.5 +/- 62.7-74.5 yrs old) males (90%) patients. The incidence of bleeding during the bridge with tirofiban was 8%, half of them were significant according to BARC classification (2% grade 3A and 2% grade 3B). The rate of acute myocardial infarction was 2% and no intrastent thrombosis was registered. None of the patients required emergency coronary angiography. Conclusions: the use of tirofiban as a bridge to surgery was associated with a moderate rate of ischemic and hemorrhagic events. Our results show that the events did not differ significantly from those reported in patients who did not require this strategy. The events in the bridge and in the postoperative period do not seem to be associated with the use of tirofiban or P2Y12 suspension.