Drug General Information (ID: DDIV871QZ6)
Drug Name			Tirofiban		Drug Info		Heparin		Drug Info
Drug Type		Small molecule				Small molecule
Therapeutic Class		Fibrinolytic Agents				Anticoagulants
Structure

Mechanism of Tirofiban-Heparin Interaction (Severity Level: Major)
Increased risk of bleeding Click to Show/Hide Mechanism Graph
Drug Name		Tirofiban				Heparin
Mechanism		Risk of bleeding Antiplatelet				Risk of bleeding Anticoagulant
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 Tirofiban and Heparin

Recommended Action
Management		Patients should be closely monitored for signs of bleeding, especially at arterial puncture sites. Glycoprotein inhibitor/heparin therapy should be discontinued immediately if serious or uncontrollable bleeding occurs or if thrombocytopenia is confirmed. Low-dose, weight-adjusted heparin is recommended in patients who are receiving abciximab and undergoing percutaneous coronary intervention. Heparin should be discontinued for 3 to 4 hours before removing the sheath.

References
1	Adderhuis KM, Deckers JW, Lincoff AM, et al. "Risk of stroke associated with abciximab among patients undergoing percutaneous coronary intervention." JAMA 286 (2001): 78-82. [PMID: 11434830]
2	Blankenship JC "Bleeding complications of glycoprotein IIb-IIIa receptor inhibitors." Am Heart J 138 (1999): s287-96. [PMID: 10502234]
3	Hirsch J, Dalen J, Guyatt G, American College of Chest Physicians "The sixth (2000) ACCP guidelines for antithrombotic therapy for prevention and treatment of thrombosis. American College of Physicians." Chest 119(1 Suppl) (2001): 1S-2S. [PMID: 11157638]
4	Juran NB "Minimizing bleeding complications of percutaneous coronary intervention and glycoprotein IIb-IIIa antiplatelet therapy." Am Heart J 138 (1999): s297-306. [PMID: 10502235]
5	Product Information. Aggrastat (tirofiban). Merck & Co, Inc, West Point, PA.
6	Product Information. Integrilin (eptifibatide). Schering Laboratories, Kenilworth, NJ.
7	Product Information. ReoPro (abciximab). Lilly, Eli and Company, Indianapolis, IN.
8	Caillard S, Leray C, Kunz K, Gachet C, Offner M, Wiesel ML, Hannedouchte T, Cazenave JP, Moulin B "Effects of cerivastatin on lipid profiles, lipid peroxidation and platelet and endothelial activation in renal transplant recipients." Transplant Proc 32 (2000): 2787-8. [PMID: 11134806]