Extracorporeal elimination of large concentrations of tirofiban by zero-balanced ultrafiltration during cardiopulmonary bypass: an in vitro investigation.

Anesthesia and Analgesia
Andreas KosterRainhard Oertel

Abstract

The short-acting platelet glycoprotein IIb/IIIa antagonist tirofiban is beneficial when used in the context of cardiac surgery. Tirofiban has an elimination half-life of 2 h. Renal failure prolongs the half-life and continues inhibition of platelet aggregation refractory to transfusions of platelets. Extracorporeal elimination is necessary to prevent excessive hemorrhage in this condition. We assessed the elimination of tirofiban by hemofiltration in an in vitro model of cardiopulmonary bypass (CPB). Two hemofilters and one plasmapheresis filter were assessed. Three separate filters of each type were tested serially. The CPB circuit was primed with a total volume of 1000 mL. Tirofiban was added to a calculated concentration of 200 ng/mL. Portions of 50 mL of filtrate were retrieved from the dialyzer, and equal amounts of fluid were substituted in the circuit. After each filtration, the tirofiban blood level was analyzed. The procedure was repeated 16 times. Peak tirofiban concentrations ranged from 160 to 260 ng/mL. The elimination of tirofiban followed an exponential decay curve with fast clearance of the large therapeutic concentrations of 250 to 50 ng/mL. The subsidence coefficient b revealed no significant differences in el...Continue Reading

References

Sep 28, 2002·Anesthesia and Analgesia·Rosaleen ChunMina Madan
Feb 5, 2003·The American Journal of Cardiology·Andreas KosterChristian W Hamm
Mar 29, 2003·Current Medical Research and Opinion·Gian B DanziRoberto Baglini
Aug 7, 2003·The Annals of Thoracic Surgery·Theodore E Warkentin, Andreas Greinacher
Sep 16, 2003·The American Journal of Cardiology·David F KongRobert M Califf
Feb 3, 2004·Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions·Gian B DanziRoberto Baglini

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Citations

Jun 13, 2006·Canadian Journal of Anaesthesia = Journal Canadien D'anesthésie·André VincentelliSylvain Bélisle
Sep 2, 2008·Critical Care : the Official Journal of the Critical Care Forum·Andreas LinkMichael Böhm
Oct 9, 2014·International Journal of Molecular Sciences·Reinaldo Barros GeraldoHelena Carla Castro
Dec 26, 2009·Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society·Katherine JamesSusan Mallett
Apr 22, 2009·The Annals of Thoracic Surgery·Theodore E WarkentinAndreas Koster

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