Rapid Health Technology Assessment of Tirofiban in the Treatment of Acute Coronary Syndrome
- VernacularTitle:替罗非班治疗急性冠状动脉综合征的快速卫生技术评估
- Author:
Chenyue QIAN
1
;
Jingjing ZHANG
2
;
Linjun XIE
3
;
Zhanhong HU
1
;
Peng MEN
4
,
5
;
Yiheng YANG
4
,
5
;
Jianguo ZHU
2
,
6
;
Liyan MIAO
2
,
6
;
Suodi ZHAI
4
,
5
;
Jie PAN
1
Author Information
1. Dept. of Pharmacy，the Second Affiliated Hospital of Soochow University，Jiangsu Suzhou 215004，China
2. Dept. of Pharmacy，the First Affiliated Hospital of Soochow University，Jiangsu Suzhou 215006，China
3. Dept. of Pharmacy，Suzhou Municipal Hospital，Jiangsu Suzhou 215002，China
4. Dept. of Pharmacy，Peking University Third Hospital，Beijing 100191，China
5. Institute for Drug Evaluation，Peking University Health Science Center，Beijing 100191，China
6. Medical Security and Drug Evaluation Profession al Committee，Jiangsu Medical Insurance Research Association，Nanjing 215004，China
- Publication Type:Journal Article
- Keywords:
Tirofiban;
Acute coronary syndrome;
Effectiveness;
Safety;
Economics;
Rapid health technology assessment
- From:
China Pharmacy
2020;31(15):1891-1896
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE：To evaluate the benefit and risk of tirofiban in the treatment of acute coronary syndrome （ACS），and to provide evidence-based reference for clinical drug selection and decision. METHODS ：Retrieved from domestic and foreign database as PubMed ，the Cochrane Library ，CNKI and Wanfang database ，during the establishment of database to Apr. 2020，two researcher independently screened the literature based on inclusion and exclusion criteria and extracted the data. After the quality evaluation of the included literatures ，based on rapid health technology assessment ，the extracted results were classifiedly evaluated and comprehensively analyzed. RESULTS ：A total of 13 researches of systematic review/Meta-analysis and 1 research of pharmacoeconomics were included. Compared with placebo ，tirofiban could significantly reduce all-cause mortality [OR ＝0.68， 95％CI（0.54，0.86），P＝0.000 1] and the incidence of major adverse cardiac events （MACE）in patients with ACS [RR ＝0.24， 95％CI（0.14，0.40），P＜0.01]，and increased the incidence of TIMI 3 [OR＝5.73，95％CI（2.99.10.97），P＜0.01]. Tirofiban and eptifibatide had similar therapeutic efficacy in the treatment of ACS ，but tirofiban significantly increased the risk of TIMI small bleeding in patients with ACS [RR ＝0.61，95％CI（0.38，0.98），P＝0.04]. For ACS patients with non-ST elevation （NSTE-ACS）， compared with placbo ，tirofiban significantly reduced the incidence of MACE [RR ＝0.76，95％ CI（0.61，0.96），P＝0.018]，but significantly increased the risk of bleeding [OR ＝1.49，95％CI（1.12，1.98），P＝0.006]，while there was no significant difference in its effects on the all-cause mortality of NSTE-ACS patients （P＞0.05）. For STEMI patients ，compared with placebo ，tirofiban significantly reduced the all-cause mortality [RR＝0.61，95％CI（0.35，1.05），P＝0.007] and the incidence of MACE [RR ＝0.63，95％ CI（0.44，0.90），P＝0.007]. When combined with liposuction ，tirofiban also significantly reduced the incidence of MACE [RR ＝ 2.05，95％CI（1.71，2.46），P＜0.01]，and significantly increased the incidence of TIMI 3 [OR＝3.18，95％ CI（2.4，4.22），P＜ 0.01]，but there was no significant difference in its effects on bleeding risk （P＞0.05）. The included pharmacoeconomic study showed that patients treated with bivalutine could get 10.07 QALYs，patients treated with heparin combined with tirofiban could get 9.98 QALYs，and the incremental cost-effectiveness ratio bivalutine compared to the latter one was 28 575.77 yuan/QALYs，which was lower than 3 times of the per capita GDP of some cities. CONCLUSIONS ：Tirofiban has good efficacy in the treatment of ACS，but it can increase the risk of bleeding than eptifibatide and placebo. Domestic bivalirudin treating for ACS has a cost-effectiveness advantage over tirofiban combined with heparin.
