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In Reply: We agree with some of the comments raised by Dr Osman and colleagues, as we noted in the discussion of the limitations of our study. Among available glycoprotein IIb/IIIa inhibitors, Abciximab is the agent of choice in the context of primary intervention. When administered in the catheterization laboratory, abciximab, which provides rapid and complete antiplatelet effect, has been shown to be superior to tirofiban when administered as a 10-µg/kg bolus.¹ When tirofiban is administered at this dose, the level of platelet inhibition reached after 10 to 15 minutes is suboptimal compared to that achieved using abciximab.

However, in the upstream setting, where the intervention is performed on top of a high and stable level of platelet inhibition, the beneficial effect of tirofiban may be considerable.² This reinforces the importance of modulating platelet reactivity at the time of intervention to optimize outcome. Increasing the bolus regimen of tirofiban from . . . [Full Text of this Article]

Marco Valgimigli, MD
vlgmrc@unife.it
University of Ferrara
Ferrara, Italy

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