Quick Reference: Tirofiban (Aggrastat®) Protocol for HIT
Tirofiban acts on the platelet glycoprotein (GP) IIb/IIIa receptors and effectively inhibits antibody-stimulated platelet aggregation. This action allows for CPB to be carried out in a more routine fashion with the use of conventional heparinization. The elimination half-life is 2 hours and no cardiovascular side effects are known. The efficiency of Tirofiban has been investigated in large clinical trials (PRISM-PLUS, RESTORE, PRISM).
- Communicate with anesthesia to make sure their central line and swan catheters are not heparin coated.
- Cell saver anticoagulant is ACD or Bivalirudin at 0.1 mg/ml.
- Heparin-bonded circuits or other heparin-coated products may be used during the procedure.
- Albumin (100ml 25%) should be added to the pump prime in order to coat the CPB circuit and reduced the risk of thrombin formation.
- Anesthesia should administer Tirofiban bolus (10 mcg/kg) 10 minutes prior to heparin administration and then begin the infusion at (0.15 mcg/kg/min).
- Administer the standard heparin bolus.
- Maintain ACT >480 seconds per standard protocol.
- Do not perform Ultrafiltration (MUF) during or after CPB.
- Stop the Tirofiban infusion 1 hour prior to termination of CPB.
- Heparin should be reversed in the normal fashion after termination of CPB.
- Avoid giving platelets if possible.
