Tirofiban-induced thrombocytopenia

Figures & data

Figure 1. (A) The mechanism of tirofiban. (B) The Pathogenesis of tirofiban-induced thrombocytopenia. Created with BioRender.com.

Table 1. Characteristics of tirofiban.

Drug name	Tirofiban
Chemical structure
Chemical name	N-(butylsulfonyl)-O-[4- (4-piperidinyl)butyl]-L-tyrosine
Substance type	Non-peptide
Inhibition modality	Selective competitive
Binding modality	Reversible
Route of administration	Intravenous
Onset	>90% inhibition of platelet aggregation seen within 10 min
Distribution	Vdss: 22–42 L
Protein Binding	65%
Plasma Half-life	2h
Platelet function recovery time	4–8 h after discontinuation
Excretion	Urine (65%) and feces (25%) primarily as unchanged tirofiban

Table 2. Reported cases of thrombocytopenia associated with tirofiban.

NO.	CITATION	YEAR	AGE	SEX	DEATH	HOS	BL	SC	EX
1	Blood. 2002;100(6):2071–2076 [18]	2002	65	M	NO	YES	0	3	NA
2	Blood. 2002;100(6):2071–2076 [18]	2002	78	M	NO	YES	0	3	NA
3	Blood. 2002;100(6):2071–2076 [18]	2002	78	F	NO	YES	0	3	NA
4	Blood. 2002;100(6):2071–2076 [18]	2002	64	M	YES	YES	3	5	1
5	Interact Cardiovasc Thorac Surg. 2002;1(2):63–65 [22]	2002	52	NR	NO	YES	0	3	NA
6	J Thromb Haemost. 2003;1(10):2248–2250 [23]	2003	70	M	NO	YES	0	1	NA
7	J Thromb Haemost. 2003;1(10):2248–2250 [23]	2003	57	M	NO	YES	2	1	NA
8	Cardiovasc Drugs Ther. 2004;18(6):503–505 [24]	2004	63	M	NO	YES	0	1	NA
9	Am J Hematol. 2004;77(1):67–71 [25]	2004	47	F	NO	YES	NR	2	NA
10	Am J Hematol. 2004;77(1):67–71 [25]	2004	67	M	NO	YES	NR	2	NA
11	Am J Hematol. 2004;77(1):67–71 [25]	2004	72	F	NO	YES	NR	2	NA
12	Angiology. 2005;56(3):351–355 [26]	2005	80	M	NO	YES	NR	3	NA
13	J Thromb Haemost. 2005;3(5):1109–1110 [16]	2005	67	M	NO	YES	NR	3	NA
14	J Thromb Haemost. 2005;3(5):1109–1110 [16]	2005	80	M	NO	YES	NR	3	NA
15	Acta Cardiol. 2006;61(5):577–579 [27]	2006	57	M	NO	YES	0	2	NA
16	J Thromb Thrombolysis. 2006;22(1):77–78 [28]	2006	58	M	NO	YES	0	2	NA
17	Pharmacotherapy. 2006;26(3):423–427 [29]	2006	51	M	NO	YES	NR	3	NA
18	J Thromb Thrombolysis. 2007;24(1):59–64 [30]	2007	62	M	NO	YES	0	2	NA
19	J Thromb Haemost. 2007;5(5):1068–1070 [15]	2007	57	M	NO	YES	NR	3	NA
20	Ann Thorac Surg. 2009;87(2):629–631 [31]	2009	63	M	NO	YES	3	3	NA
21	Tex Heart Inst J. 2009;36(1):55–57 [32]	2009	58	M	NO	YES	3	3	NA
22	Tex Heart Inst J. 2010;37(1):109–112 [33]	2010	50	M	NO	YES	NR	3	NA
23	Indian J Pharmacol. 2011;43(6):726–728 [34]	2011	44	M	NO	YES	0	2	NA
24	Int J Hematol. 2012;96(3):370–375 [35]	2012	73	M	NO	YES	2	2	NA
25	Int J Hematol. 2012;96(3):370–375 [35]	2012	47	M	NO	YES	NR	2	NA
26	Asian Cardiovasc Thorac Ann. 2013;21(1):74–76 [36]	2013	55	M	NR	NR	NR	3	NA
27	Platelets. 2013;24(4):335–337 [10]	2013	87	F	NR	NR	NR	3	NA
28	Case Rep Med. 2014;2014:190149 [37]	2014	50	M	NO	YES	1	3	NA
29	Platelets. 2015;26(2):197–198 [17]	2015	40	M	NO	YES	0	3	NA
30	Exp Ther Med. 2016;12(2):1177–1180 [38]	2016	68	M	NO	YES	NR	2	NA
31	Int J Cardiol. 2016;206:93–94 [19]	2016	66	M	YES	YES	3	5	1
32	Case Rep Cardiol. 2016;2016:4605139 [20]	2016	69	M	NO	YES	2	3	NA
33	Case Rep Hematol. 2018;2018:4357981 [39]	2018	79	M	NO	YES	0	2	NA
34	Am J Ther. 2019;26(4):e534–e537 [40]	2019	79	M	NO	YES	0	2	NA
35	Am J Ther. 2019;26(5):e659–e661 [41]	2019	64	M	NO	YES	1	2	NA
36	Pharmacotherapy. 2019;39(4):521–525 [42]	2019	59	M	NO	YES	0	2	NA
37	J Investig Med High Impact Case Rep. 2020;8:2324709620947891 [43]	2020	66	F	NO	YES	1	2	NA
38	J Community Hosp Intern Med Perspect. 2020;10(2):171–173 [44]	2020	69	F	NO	YES	1	2	NA
39	Cureus. 2021;13(9):e18217 [45]	2021	68	M	NO	YES	1	2	NA
40	Pan Afr Med J. 2021;38:9 [46]	2021	65	F	NO	YES	3	2	NA
41	Pan Afr Med J. 2021;38:9 [46]	2021	76	F	NO	YES	1	2	NA
42	Am J Ther. 2022;10.1097/MJT.0000000000001553 [47]	2022	42	M	NO	YES	0	2	NA
43	Heliyon. 2023;9(4):e14504 [48]	2023	59	F	NO	YES	0	2	NA

F: female; M: male; HOS: Hospitalized; BL: Bleeding; SC: Score; EX: Exclusion; NR: Not Recorded; NA: Not Applicable.

Table 3. Summary of thrombocytopenia occurrence in studies of tirofiban.

NO.	CITATION	YEAR	AGE	TOTAL TCP	EX TCP	CT TCP	SC	EX
1	Circulation. 1997;96(5):1445–1453 [14]	1997	ADULT	22	12	10	4	NA
2	N Engl J Med. 1998;338(21):1488–1497 [49]	1998	ADULT	21	15	6	4	NA
3	N Engl J Med. 1998;338(21):1498–1505 [13]	1998	ADULT	24	18	6	1	NA
4	N Engl J Med 2001;344:1888–1894 [12]	2001	NR	70	12	58	1	NA
5	J Am Coll Cardiol. 2004;44(1):14–19 [50]	2004	NR	2	1	1	5	1
6	Platelets. 2005;16(8):462–468 [51]	2005	ADULT	11	NR	NR	3	NA
7	JAMA. 2005;293(17):2109–2117 [52]	2005	NR	9	1	8	1	NA
8	JAMA. 2008;299(15):1788–1799 [53]	2008	NR	18	3	15	1	NA
9	Lancet 2008;372(9638):537–546 [54]	2008	ADULT	19	10	9	4	NA
10	Eur J Clin Pharmacol. 2012;68(5):821–832 [55]	2012	ADULT	10	9	1	2	NA
11	Stroke. 2021;52(12):3750–3758 [56]	2021	ADULT	1	1	0	4	NA

Total TCP: Total number of patients with thrombocytopenia; EX TCP: The number of people in the experimental group that developed thrombocytopenia; CT TCP: The number of people in the control group that developed thrombocytopenia; SC: Score; EX: Exclusion; NR: Not Recorded; NA: Not Applicable.

Table 4. Scores points for the independent variables [8].

Risk factors	Points
Age
≥65 years	2
50–65 years	0
White blood cell
≥12 × 10^9/L	1
<12 × 10^9/L	0
Diabetes mellitus
Yes	2
No	0
Congestive Heart failure
Yes	2
No	0
Chronic kidney disease
Yes	1
No	0

Total score: ≤2: Low-risk; 3–6: Moderate-risk; ≥7: High-risk.

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Data availability statement

Data sharing is not applicable to this article as no new data were created or analyzed in this study.