2025 Southeastern Residency Conference

Title: Safety Outcomes of Tirofiban Weight Based Dosing Strategy in Overweight Patients
Authors: Merrie Barnett-Brock, Audrey Johnson, Sofiya Paciotti
Background: Tirofiban is a GIIb/GIIIa receptor antagonist therapy used for the treatment of myocardial revascularization in non-ST elevation myocardial infarction (NSTEMI) and ST elevation myocardial infarction (STEMI). Tirofiban dosing is weight based utilizing actual body weight. There is a hole in the literature regarding studies with information regarding safety outcomes in patients >85kg, including obese patients. Specifically, the previous literature lacks any information regarding safety outcomes in obese patients. Current studies show incidence of bleeding ranging from 0.4% to 5%. This is a major gap in the literature that this study hopes to resolve. 
Methods: This IRB-approved, retrospective, single-center cohort study included patients from a 711-bed academic medical center in Savannah, Georgia. Adult patients treated with tirofiban for cardiac conditions at Memorial Health University Medical Center between January 1, 2015 and September 27, 2024 were utilized as the cohort. Other inclusion criteria included receipt of tirofiban ≥1 hour and patients dosed on actual body weight with renal dose adjustment using a creatinine clearance calculation with actual body weight. Patients were excluded if they were a protected population or if the patients were discharged <48 hours from when infusion started. The aim of this study was to assess the safety outcomes of patients with a weight ≥85 kg with a primary outcome of major bleeding defined by the ISTH criteria and secondary outcomes of minor bleeding, mortality, and rescue agents utilized. These outcomes were further assessed amongst subgroups based on BMI, renal function, and weight. The BMI subgroups included 3 categories, category one being BMI <30 kg/ m², category two being BMI 30-40 kg/m², and category three being BMI >40 kg/m². The weight subgroups included three categories, category one being 85-119.9 kg, category two being 120-149.9 kg, and category three being ≥150 kg. 
Results: Of the 304 patients screened, 47 were included in the final analysis. The majority of patients were white males and no patients were found to have renal dysfunction. The median weight observed in the patient population was 98 kg and the median BMI was 30.7 kg/m². We observed a 29.7% incidence of major of bleeding. For the subgroups defined by BMI, major bleeding was found to be 44.4% in the category 1 patients, 17.3% in the category 2 patients, and 33.3% in the category 3 patients. Major bleeding occurred specifically in the weight subgroups with 30.9% of the category 1 patients, 25% of the category 2 patients, and 0% in category 3 patients. Secondary outcomes in the overall cohort included mortality in 2.1% of the population, minor bleeding in 12.7%, and 2.1% of the patients utilized a rescue agent.
Conclusions: This retrospective study provides descriptive information regarding major bleeding occurrences in patients weighing ≥85 kg where both BMI and weight subgroups were observed. We observed 29.7% of the patient population experienced major bleeding. These findings demonstrate that further research with adequately powered studies are needed to show the incidence of major bleeding amongst higher weight patients receiving tirofiban. 
Disclosures: "This research was supported (in whole or in part) by HCA Healthcare and/or an HCA Healthcare affiliated entity. The views expressed in this publication represent those of the author(s) and do not necessarily represent the official views of HCA Healthcare or any of its affiliated entities."
Best contact point for follow up of interested participants: merrie.barnettbrock@hcahealthcare.com