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| Peri-operative anti-thrombotic safety and efficiency of tirofiban for patients undergoing emergency operation of CIED after implantation of drug-eluting stent |
| Li Xiang-xin, Zhang Lan-fang, Zhang fang, Jia Xin-wei, Zhao Shu-jun, Feng Cui-na, Wang Zhan-qi |
| Department of Cardiovascular Medicine, the Affiliated Hospital of Hebei University, Baoding 071000, China |
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Abstract Objective To evaluate the peri-operative anti-thrombotic safety and efficiency of tirofiban for patients undergoing emergency operation of cardiovascular implantable electronic devices (CIED) after implantation of drug-eluting stent. Methods A total of 40 patients who having taken dual antiplatelet therapy (DAPT) drugs (clopidogrel and aspirin) within 6 month after DES and undergoing emergency implantation of CIED in our department were recruited in this study. All patients were divided into two groups. Tirofiban group (20 cases): Clopidogrel was discontinued 5 days before the operation and instead of tirofiban intravenous infusion of 0.4 μg/(kg·min) over 30 min, followed by 0.1 mg /(kg·min). The infusion was stopped 4 h before surgery; clopidogrel was returned using a loading dose of 300 mg and then continued at a once daily dose of 75 mg after CIED implantation 12-24 hours according to the bleeding condition. Asprin was continued throughout the perioperative period. DAPT group (20 cases): continuous aspirin and clopidogrel therapy during perioperative period. Close postoperative monitoring is performed. A 18-lead ECG was recorded every morning during the CCU stay and 6 h or more after any suspicious symptoms or ECG signs of ischemia. Blood test for CK-MB was collected every day. In the case of an increase in CK-MB levels, further samples were collected at 6-8 h intervals until the values had normalized. During the period of tirofiban intravenous infusion, blood routine was checked every 6-8 hour. MACE and pocket hemorrhage were followed up for 3 months. Results There was no significant difference in age, gender, disease constitution, type of pacemaker operation time and hospitalization time between the two groups. There were no incidences of death, in-stent thrombosis, repeat myocardial infarction, TVR within 3 months after procedure. The total bleeding rate (20.0% vs. 30.0%， P=0.715), the rate of errhysis (15.0% vs. 20.0%，P=0.677) and the incidence of pocket hematoma (5.0% vs. 10.0%，P=1.000). The incidence in tirofiban group were less than those in DAPT group, but there was no significant difference between the two groups（P>0.05）. Conclusion The use of tirofiban as bridging therapy undergoing emergency operation of CIED after implantation of drug-eluting stent is safe and efficiency in our small study population.
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Corresponding Authors:
Wang Zhan-qi, E-mail: 13930851971@163.com
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