Drug General Information (ID: DDI72AI63N)
Drug Name			Dicoumarol		Drug Info		Tirofiban		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Anticoagulants				Fibrinolytic Agents
Structure

Mechanism of Dicoumarol-Tirofiban Interaction (Severity Level: Major)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Dicoumarol				Tirofiban
Mechanism		Risk of bleeding Anticoagulant				Risk of bleeding Antiplatelet
Key Mechanism Factor 1
		Factor Name		Bleeding
		Factor Description		Patients may be at risk for bleeding when the outcome of a disease or disease treatment confounds the standard mechanisms for maintaining hemostasis. Signs or symptoms of abnormal bleeding include: bleeding that takes a long time to stop (including nosebleeds, bleeding gums, bleeding from cuts and abrasions, and menstrual bleeding); severe unexplained bruising, or bruising that becomes larger; blood in the urine or stool, etc.
Mechanism Description		Increased risk of bleeding by the combination of Dicoumarol and Tirofiban

Recommended Action
Management		Some manufacturers of GP IIb/IIIa inhibitors consider their use contraindicated if patients have received oral anticoagulants within 7 days unless the prothrombin time is less than or equal to 1.2 times control. Bleeding precautions should be observed and patients should be closely monitored for clinical and laboratory evidence of adverse effects.

References
1	Guo LQ, Yamazoe Y "Inhibition of cytochrome P450 by furanocoumarins in grapefruit juice and herbal medicines." Acta Pharmacol Sin 25 (2004): 129-36. [PMID: 14769198]
2	Product Information. Integrilin (eptifibatide). Schering Laboratories, Kenilworth, NJ.
3	Product Information. ReoPro (abciximab). Lilly, Eli and Company, Indianapolis, IN.