Aspirin with Tirofiban Interaction Details

Brand Names Associated with Aspirin

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Mar 04, 2024

Interaction Effect

An increased risk of bleeding

Interaction Summary

Tirofiban was studied in combination with heparin and aspirin in three large clinical trials involving 3948 patients. The incidence of bleeding was increased with tirofiban and heparin coadministration as compared to heparin alone. Patients also received aspirin unless it was contraindicated[1]. Caution is recommended with the concomitant use of aspirin, an antiplatelet agent [2], and tirofiban, a platelet aggregation inhibitor, due to the increased risk of bleeding [1]. If coadministration cannot be avoided, monitoring of signs and symptoms of active bleeding may be warranted.

Severity

Major

Onset

Unspecified

Evidence

Probable

How To Manage Interaction

Concomitant use of aspirin, an antiplatelet agent[2], and tirofiban, a platelet aggregation inhibitor, increases the risk of bleeding and should be undertaken with caution [1]. Patients should be closely monitored for signs and symptoms of active bleeding.

Mechanism Of Interaction

Additive antiplatelet effects

Literature Reports

A) In the PRISM-PLUS (Platelet Receptor Inhibition for Ischemic Syndrome Management - Patients Limited by Unable Signs and Symptoms) study, 1.4% of 773 patients who received heparin and tirofiban experienced a major bleeding episode, as compared to 0.8% of 797 patients who received only heparin. Similarly, in the RESTORE (Randomized Efficacy Study of Tirofiban for Outcomes and Restenosis) study, 2.2% of 1071 patients on tirofiban and heparin had a major bleeding episode, compared to 1.6% of 1070 patients on heparin alone. A major bleeding episode was defined as a hemoglobin drop of greater than 50 g/L with or without an identified site, intracranial hemorrhage, or cardiac tamponade. All patients were also receiving aspirin unless contraindicated. Minor bleeding episodes, defined as a hemoglobin drop of greater than 30 g/L with bleeding from a known site, spontaneous gross hematuria, hematemesis, or hemoptysis, occurred in 10.5% of patients receiving tirofiban and heparin in the PRISM-PLUS study, and only 8% of patients on heparin monotherapy. In the RESTORE study, 12% of tirofiban/heparin recipients had a minor bleed in contrast to 6.3% on heparin alone [1].

References

1 ) Product Information: AGGRASTAT(R) intravenous injection solution, tirofiban HCl intravenous injection solution. Medicure Pharma, Inc. (per DailyMed), Somerset, NJ, 2012.

2 ) Product Information: AGGRENOX(R) oral extended release capsules, aspirin dipyridamole oral extended release capsules. Boehringer Ingelheim Pharmaceuticals, Inc. (per FDA), Ridgefield, CT, 2012.

Aspirin Overview

• Prescription aspirin is used to relieve the symptoms of rheumatoid arthritis (arthritis caused by swelling of the lining of the joints), osteoarthritis (arthritis caused by breakdown of the lining of the joints), systemic lupus erythematosus (condition in which the immune system attacks the joints and organs and causes pain and swelling) and certain other rheumatologic conditions (conditions in which the immune system attacks parts of the body). Nonprescription aspirin is used to reduce fever and to relieve mild to moderate pain from headaches, menstrual periods, arthritis, toothaches, and muscle aches. Nonprescription aspirin is also used to prevent heart attacks in people who have had a heart attack in the past or who have angina (chest pain that occurs when the heart does not get enough oxygen). Nonprescription aspirin is also used to reduce the risk of death in people who are experiencing or who have recently experienced a heart attack. Nonprescription aspirin is also used to prevent ischemic strokes (strokes that occur when a blood clot blocks the flow of blood to the brain) or mini-strokes (strokes that occur when the flow of blood to the brain is blocked for a short time) in people who have had this type of stroke or mini-stroke in the past. Aspirin will not prevent hemorrhagic strokes (strokes caused by bleeding in the brain). Aspirin is in a group of medications called salicylates. It works by stopping the production of certain natural substances that cause fever, pain, swelling, and blood clots.

• Aspirin is also available in combination with other medications such as antacids, pain relievers, and cough and cold medications. This monograph only includes information about the use of aspirin alone. If you are taking a combination product, read the information on the package or prescription label or ask your doctor or pharmacist for more information.

Return To Our Drug Interaction Homepage

Feedback, Question Or Comment About This Information?

Definitions

Severity Categories

Contraindicated

These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.

Major

This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.

Moderate

This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.

Minor

While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.

Onset

Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.

Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.

Evidence

Level of documentation of the interaction.

Established: The interaction is documented and substantiated in peer-reviewed medical literature.

Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.

How To Manage The Interaction

Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.

It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.

Mechanism Of Interaction

The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.

Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.

Where Does Our Information Come From?

Information for our drug interactions is compiled from several drug compendia, including:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

The prescribing information for each drug, as published on DailyMED, is also used. 

Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.

The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.