Aggrastat

Aggrastat

tirofiban

(tye-roe-fye-ban) ,

Aggrastat

(trade name) Pregnancy Category: B

Indications

Action

Pharmacokinetics

Time/action profile (effects on platelet function)

ROUTE	ONSET	PEAK	DURATION
IV	rapid	30 min†	brief‡

†>90% inhibition of platelet aggregation at end of initial 30-min infusion‡Inhibition is reversible following cessation of infusion

Contraindications/Precautions

Adverse Reactions/Side Effects

Noted for patients receiving heparin and aspirin in addition to tirofiban

Central nervous system

• dizziness
• headache (most frequent)

Cardiovascular

• bradycardia
• coronary dissection
• edema
• vasovagal reaction

Gastrointestinal

• nausea

Dermatologic

• hives
• rash

Hematologic

• bleeding
• thrombocytopenia

Musculoskeletal

• leg pain

Miscellaneous

• fever
• hypersensitivity reactions
• pelvic pain
• sweating

Interactions

Drug-Drug interaction

Concurrent use of aspirin, NSAIDs, warfarin, heparin, heparin-like agents, abciximab, eptifibatide, clopidogrel, ticlopidine, or dipyridamole may ↑ risk of bleeding, although these agents are frequently used together or in sequence.Risk of bleeding may be ↑ by concurrent use of cefotetan, cefoperazone, or valproic acid.↑ anticoagulant effect and bleeding risk with anise, arnica, chamomile, clove, dong quai, fenugreek, feverfew, garlic, ginger, ginkgo, Panax ginseng, licorice, and others.

Route/Dosage

Availability

Nursing implications

Nursing assessment

• Assess for bleeding. Most common is oozing from the arterial access site for cardiac catheterization. Arterial and venous punctures, IM injections, and use of urinary catheters, nasotracheal intubation, and nasogastric tubes should be minimized. Noncompressible sites for IV access should be avoided. If bleeding cannot be controlled with pressure, discontinue tirofiban and heparin immediately.
• During vascular access, avoid puncturing posterior wall of femoral artery. Maintain bedrest with head of bed elevated 30° and affected limb restrained in a straight position while the vascular sheath is in place. Heparin should be discontinued for 3–4 hr and activated clotting time (ACT) <180 sec or activated partial thromboplastin time (aPTT) <45 sec prior to pulling the sheath. Use compressive techniques to obtain hemostasis and monitor closely. Sheath hemostasis should be maintained for >4 hr before discharge from the hospital.
• Monitor for signs of thrombocytopenia (chills, low-grade fever) during therapy.
• Lab Test Considerations: Assess hemoglobin, hematocrit, and platelet count prior to tirofiban therapy, within 6 hr following loading infusion, and at least daily during therapy (more frequently if evidence of significant decline). May cause ↓ hemoglobin and hematocrit.
  • If platelet count ↓ to <90,000/mm³, perform additional platelet counts to rule out pseudothrombocytopenia. If thrombocytopenia is confirmed, tirofiban and heparin should be discontinued and condition monitored and treated.
  • To monitor unfractionated heparin, assess aPTT 6 hr after the start of heparin infusion. Adjust heparin to maintain aPTT at approximately 2 times control.
  • May cause presence of urine and fecal occult blood.

Potential Nursing Diagnoses

Ineffective tissue perfusion (Indications)

Implementation

• Do not confuse Aggrastat (tirofiban) with argatroban.
• high alert: Use of antiplatelet medications has resulted in patient harm and/or death from internal hemorrhage or intracranial bleeding. Have second practitioner independently check original order, dosage calculations, and infusion pump settings.
• Most patients receive heparin and aspirin concurrently with tirofiban.
  • Do not administer solutions that are discolored or contain particulate matter. Discard unused portion.

• Intravenous Administration

• pH: 5.5–6.5.
• Intermittent Infusion: Diluent: Tirofiban injection premix is ready for administration and dose not require any further dilution.Concentration: 50 mcg/mL.
• Rate: Based on patient's weight (see Route/Dosage section).
• Y-Site Compatibility: acyclovir, alfentanil, allopruinol, amifostine, amikacin, aminocaproic acid, aminophylline, amiodarone, ampicillin, ampicillin/sulbactam, anidulafungin, argatroban, arsenic trioxide, atracurium, atropine, azithromycin, aztreonam, bivalirudin, bleomycin, bumetanide, buprenorphine, busulfan, butorphanol, calcium chloride, calcium gluconate, capreomycin, carboplatin, carmustine, caspofungin, cefazolin, cefepime, cefotaxime, cefotetan, cefoxitin, ceftazidime, ceftriaxone, cefuroxime, chloramphenicol, chlorpromazine, ciprofloxacin, cisatracurium, cisplatin, clindamycin, cyclophosphamide, cyclosporine, cytarabine, dacarbazine, dactinomycin, daptomycin, dexamethasone, dexmedetomidine, dexrazoxane, digoxin, diltiazem, diphenhydramine, dobutamine, docetaxel, dolasetron, dopamine, doxacurium, doxorubicin, doxorubicin liposome, doxycycline, droperidol, enalaprilat, ephedrine, epinephrine, epirubicin, eptifibatide, ertapenem, erythromycin, esmolol, etoposide, etoposide phosphate, famotidine, fenoldopam, fentanyl, fluconazole, fludarabine, fluorouracil, foscarnet, fosphenytoin, furosemide, ganciclovir, gemcitabine, gentamicin, glycopyrrolate, granisetron, haloperidol, heparin, hydralazine, hydrocortisone, hydromorphone, idarubicin, ifosfamide, imipenem/cilastatin, insulin, irinotecan, isoproterenol, ketorolac, labetalol, leucovorin, levofloxacin, lidocaine, linezolid, lorazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, meropenem, mesna, methylhexital, methotrexate, methyldopate, methylprednisolone, metoclopramide, metoprolol, metronidazole, midazolam, milrinone, mitomycin, mitoxantrone, morphine, moxifloxacin, mycophenolate, nafcillin, nalbuphine, naloxone, nesiritide, nicardipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxaliplatin, oxytocin, paclitaxel, palonosetron, pamidronate, pancuronium, pantoprazole, pemetrexed, pentobarbital, phenobarbital, phentolamine, phenylephrine, piperacillin/tazobactam, potassium acetate, potassium chloride, potassium phosphates, procainamide, prochlorperazine, promethazine, propranolol, quinupristin/dalfopristin, ranitidine, remifentanil, rocuronium, sodium acetate, sodium bicarbonate, sodium phosphates, streptozocin, succinylcholine, sufentanil, tacrolimus, teniposide, theophylline, thiopental, thiotepa, ticarcillin/clavulanate, tigecycline, tobramycin, topotecan, vancomycin, vasopressin, vecuronium, verapanil, vinblastine, vincristine, vinorelbine, voriconazole, zidovudine, zoledronic acid
• Y-Site Incompatibility: amphotericin B colloidal, amphotericin B lipid complex, dantrolene, diazepam, phenytoin

Patient/Family Teaching

• Inform patient of the purpose of tirofiban.
• Instruct patient to notify health care professional immediately if any bleeding is noted.

Evaluation/Desired Outcomes

• Inhibition of platelet aggregation resulting in decreased incidence of new MI, death, or refractory ischemia with the need for repeat cardiac procedures.