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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).
  1. Communicate with anesthesia to make sure their central line and swan catheters are not heparin coated.
  2. Cell saver anticoagulant is ACD or Bivalirudin at 0.1 mg/ml.
  3. Heparin-bonded circuits or other heparin-coated products may be used during the procedure.
  4. Albumin (100ml 25%) should be added to the pump prime in order to coat the CPB circuit and reduced the risk of thrombin formation.
  5. 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).
  6. Administer the standard heparin bolus.
  7. Maintain ACT >480 seconds per standard protocol.
  8. Do not perform Ultrafiltration (MUF) during or after CPB.
  9. Stop the Tirofiban infusion 1 hour prior to termination of CPB.  
  10. Heparin should be reversed in the normal fashion after termination of CPB.
  11. Avoid giving platelets if possible.

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