Eptifibatide Bolus Research Articles

Abstract WP25: Eptifibatide in Acute Ischemic Strokes Without Large Vessel Occlusions

Background: Platelet glycoprotein IIb/IIIa inhibitors are currently being researched for patients with acute ischemic stroke (AIS), however there is no consensus on which inhibitor or dose is both safe and effective. Tirofiban has recently been studied, however it was associated with an increased risk of intracranial bleeding. In this study we share our experience using eptifibatide given it has shown to be as effective as tirofiban with a better safety profile. Methods: In this multi-center retrospective analysis, we screened 102 patients who received an eptifibatide bolus of 135 mcg/kg followed by 0.5 mcg/kg/min infusion and 332 patients treated with usual stroke care between December 2022 and May 2023. Patients were excluded if the NIHSS on presentation but within 24 hours of last known well was less than 3 or if the patient had a large vessel occlusion (LVO). There were 7 and 31 patients included in the eptifibatide and usual care group respectively. Our primary endpoint was change in NIHSS from admission to discharge. Our safety endpoints were symptomatic ICH and any ICH. Results: No patients included in the study experienced a symptomatic ICH. The median time of eptifibatide infusion was 24 hours with some patients receiving the infusion for multiple days. Conclusion: While larger studies are needed to confirm our findings, eptifibatide may be safe and effective in the treatment of AIS without LVO.

Safety and efficacy of eptifibatide in acute ischemic stroke requiring extracranial carotid artery stenting.

The antiplatelet management in acute ischemic stroke requiring carotid artery stenting is heterogenous, with no clear guidelines to direct management. To evaluate the safety and efficacy of an intravenous eptifibatide protocol in the management of acute ischemic stroke requiring emergent carotid artery stenting. We performed a retrospective analysis of consecutive patients who underwent carotid artery stenting for acute ischemic stroke at a high-volume tertiary neuroscience center, who were managed with an intravenous eptifibatide protocol. The protocol consists of an intravenous loading eptifibatide bolus (180 mcg/kg) at the time of stenting, followed by a maintenance infusion of 1 mcg/kg/min, then oral or nasogastric loading of dual antiplatelet agents. 80 patients were included for analysis. Median presenting NIHSS was 17. Sixty-six patients (83%) had a tandem intracranial occlusion. Six (7.5%) patients developed symptomatic intracranial hemorrhage (sICH). Those who received intravenous thrombolysis were not more likely to develop sICH (10% vs 5%, p = 0.40). Those patients with a presenting ASPECTS <8 were significantly more likely to develop sICH than those with ASPECTS 8-10 (25% vs 3%, p = 0.004). Eptifibatide may have a role in the management of acute stroke requiring carotid stenting. Caution may be required in those with established infarct on presentation imaging.

A Double-Blinded Randomized Controlled Trial Comparing Eptifibatide Bolus Only Versus Bolus Plus Infusion in Patients Undergoing Primary Percutaneous Coronary Intervention for St-Elevation Myocardial Infarction Revealed Similar Outcome

A Double-Blinded Randomized Controlled Trial Comparing Eptifibatide Bolus Only Versus Bolus Plus Infusion in Patients Undergoing Primary Percutaneous Coronary Intervention for St-Elevation Myocardial Infarction Revealed Similar Outcome

CRT-100.32 A Double-Blinded Randomized Controlled Trial Comparing Eptifibatide Bolus Only Versus Bolus Plus Infusion in Patients Undergoing Primary Percutaneous Coronary Intervention for St-Elevation Myocardial Infarction Revealed Similar Outcome

CRT-100.32 A Double-Blinded Randomized Controlled Trial Comparing Eptifibatide Bolus Only Versus Bolus Plus Infusion in Patients Undergoing Primary Percutaneous Coronary Intervention for St-Elevation Myocardial Infarction Revealed Similar Outcome

A Double-Blinded Randomized Controlled Trial Comparing Eptifibatide Bolus Only Versus Bolus Plus Infusion In Patients Undergoing Primary Percutaneous Coronary Intervention For ST-Elevation Myocardial Infarction

BackgroundsThe use of eptifibatide combined with heparin during percutaneous coronary intervention (PCI) in patients presenting with ST-elevation myocardial infarction (STEMI) is recommended to be followed by continuous infusion. Recently, there are some suggestions that using bolus only may be sufficient and cost-effective but randomized trials are lacking. AimsThe goal of this study was to evaluate these two approaches in a double-blinded randomized control trial. MethodsThe primary PCI patients who received bolus eptifibatide were randomized to 75 mg IV eptifibatide infusion or placebo blindly. The patients were followed up for the primary outcome of vascular or bleeding complications and secondary outcome of ischemic complications. Results330 patients (165 from each group) completed the study. The mean age was 57.67 ± 11.53 years and 77.3 % were male. Major bleeding was seen in 1 patient in each group. Hematoma occurred in 8.5 %. The relative risk of hematoma and ecchymosis in bolus plus infusion group to bolus only group were 0.988 (95 % CI: 0.486–2.006) and 1.032 (95 % CI: 0.729–1.459). Multivariate analysis confirmed no significant differences in the bleeding event. Furthermore, there was no significant difference in in-hospital death or any ischemic events. (Cath lab death: 1.4 % in bolus only vs zero % in the control group, p = 0.217, stent thrombosis was seen in one patient in each group). ConclusionThere were no differences in the risk of access site ecchymosis, hematoma or major bleeding. Ischemic events and stent thrombosis rates were also similar. Our study suggests that using eptifibatide bolus only during PCI of patients with STEMI is safe and can be cost-saving.

TCTAP A-004 Effectiveness of Intracoronary Eptifibatide Bolus Only on Myocardial Perfusion During Primary Percutaneous Coronary Intervention in Patient Presented with ST-Segment Elevation Myocardial Infarction: A Real-World Evidence

TCTAP A-004 Effectiveness of Intracoronary Eptifibatide Bolus Only on Myocardial Perfusion During Primary Percutaneous Coronary Intervention in Patient Presented with ST-Segment Elevation Myocardial Infarction: A Real-World Evidence

Tracheoinnominate fistula: acute bleeding and hypovolemic shock due to a trachea-innominate artery fistula after long-term tracheostomy, treated with a stent-graft

BackgroundA tracheo-innominate fistula is a rare but life-threatening complication of tracheostomy and has a mortality rate of 100% without therapy. The underlying cause is an acquired fistula between the brachiocephalic trunk and the trachea, induced by a tracheostomy cannula’s mechanical impact.Case presentationA 25-year-old female was admitted with pulsatile bleeding from a tracheostomy. The cause of the bleeding was a tracheo-innominate artery fistula, which was difficult to recognize. Said fistula was treated with implantation of a self-expanding stent-graft. The bleeding stopped immediately after the implantation of the stent-graft. Dual antiplatelet medication with aspirin IV and ticagrelor PO, bridged with a bolus of eptifibatide IV, was started right after the stent deployment.ConclusionsEndovascular self-expanding stent-graft implantation is a viable treatment option for tracheo-innominate artery fistulae, especially in hemorrhagic emergencies.

Efficacy and Safety of Abbreviated Eptifibatide Treatment in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention

The glycoprotein IIb/IIIa inhibitor eptifibatide, administered as bolus followed by infusion, is an adjunctive antithrombotic treatment during primary percutaneous coronary intervention (PCI) in selected patients with ST-segment elevation myocardial infarction (STEMI). Whether both bolus and infusion are necessary to improve outcomes is unknown. We hypothesized that primary PCI with eptifibatide bolus only is non-inferior to the conventional treatment (bolus and infusion) with regard to infarct size, while reducing bleeding complications. We analyzed 720 consecutive STEMI patients receiving eptifibatide bolus only or conventional treatment in an observational case-control study utilizing propensity score matching of clinical and intervention-specific confounders. Infarct size was estimated based on myocardial bound creatine kinase, creatine kinase (CK), and CK area under the curve values, with a prespecified non-inferiority margin of 20%. Major bleeding was defined as type 2, 3, or 5 on the Bleeding Academic Research Consortium classification. Eptifibatide bolus only was administered to 147 patients (20%), which were matched 1:1 to patients receiving conventional treatment. Based on peak myocardial bound creatine kinase, CK and CK area under the curve values, infarct size was -8.4% (95% CI [-31.2%, 14.4%]), -11.6% (95% CI [-33.5%, 10.3%]), and -13.9% (95% CI [-34.1%, 6.2%]) after eptifibatide bolus, respectively, reaching prespecified noninferiority compared with conventional treatment. Bolus treatment significantly reduced major bleeding complications (OR 0.48, 95% CI [0.30, 0.79]). In conclusion, eptifibatide given as abbreviated bolus only to selected STEMI patients who underwent primary PCI was noninferior regarding infarct size and resulted in less bleeding complications compared with conventional bolus and infusion treatment.

Eptifibatide use following emergent carotid stenting in acute anterior circulation ischemic stroke with tandem occlusion

BackgroundEarly revascularization of the extracranial internal carotid artery in acute anterior circulation ischemic stroke (ACIS) is feasible and may improve clinical outcome. When a stent is deployed, antithrombotic agents should be administered peri-procedurally to ensure stent patency. Our institution implemented a protocol for the use of eptifibatide as a means of maintaining stent patency in the treatment of ACIS associated with cervical internal carotid artery occlusion. MethodsOur internal database was queried for patients who received emergent endovascular therapy (ET) for ACIS with stent placement and eptifibatide administration between July 2016 and 2019. ResultsTwenty nine patients met the study criteria. The etiology was large artery atherosclerosis in 26 cases. Two patients had a dissection (7%), and one had a carotid occlusion related to a recent carotid endarterectomy. Mean NIHSS was 14. Sixteen patients received IVrtPA. Extracranial-intracranial tandem occlusion (TO) was present in 21 of cases. All patients received an eptifibatide bolus followed by an infusion for approximately 24 hours post stent deployment. Head CT was obtained prior to initiation of oral dual antiplatelet therapy with aspirin and clopidogrel. Successful recanalization was achieved in all patients with no evidence of downstream embolization. Symptomatic intracerebral hemorrhage occurred in one patient. Stent occlusion occurred in two patients, only one of which was symptomatic. Favorable clinical outcome with mRS ≤ 2 at 3 months was achieved in seventeen patients. ConclusionsThe use of eptifibatide post procedure was associated with low risk of symptomatic intracranial hemorrhage, including in patients treated with rtPA.

Stent-retriever thrombectomy through an occluded pipeline embolization device

A 71-year-old female with a history of a right medial paraclinoid aneurysm was treated with pipeline embolization device and placed on dual antiplatelet therapy for 6 months. Clopidogrel was discontinued at 6 months, and the patient developed dysarthria, left-hemiplegia, and left-sided facial droop two days later. A CT angiogram demonstrated thrombus formation in the pipeline embolization device resulting in complete carotid occlusion. She presented greater than 6 h from onset and so no rt-PA was given. An eptifibatide bolus and drip was started. The patient was taken for mechanical thrombectomy given a favorable MR-perfusion pattern. Despite very tenacious clot within the device, successful revascularization was achieved using a stent retriever in the device.

Eptifibatide Bolus Dose During Elective Percutaneous Coronary Intervention.

BackgroundEptifibatide is a platelet glycoprotein IIb/IIIa receptor antagonist used for the prevention of cardiac ischemic complications of percutaneous coronary intervention (PCI). Eptifibatide has been used with bolus dose only or bolus plus infusion in patients undergoing PCI which have shown less complications, but the risk of bleeding has been increased. We aimed to compare the outcome and bleeding rate of bolus dose alone or plus infusion in elective PCI.MethodsIn this quasi-experimental study, we compared the outcome of elective PCI following single bolus dose intracoronary (41 patients) or bolus plus intravenous infusion (19 patients) of eptifibatide. In-hospital and follow-up major adverse cardiac events (MACEs) and bleeding rate were recorded and evaluated between groups.ResultsBoth groups were comparable regarding baseline findings. Bolus only compared to bolus plus infusion group had lower in-hospital (19.5% vs. 31.6%) and follow-up MACE (15.4% vs. 17.6%), lower bleeding in-hospital (14.6% vs. 21.1%) and follow-up (2.4% vs. 5.3%) as well as lower mortality rate in hospital (4.9% vs. 15.8%), but higher follow-up mortality (10.3% vs. 0), but the difference was not significant.ConclusionsWe observed no significant difference regarding bleeding or MACE between intracoronary bolus infusion and bolus plus intravenous infusion of eptifibatide. It seems intracoronary bolus infusion of eptifibatide due to use of lower doses is a better choice in elective PCI to prevent post-PCI MACE.

Ticagrelor and Eptifibatide Bolus Versus Ticagrelor and Eptifibatide Bolus With 2-Hour Infusion in High-Risk Acute Coronary Syndromes Patients Undergoing Early Percutaneous Coronary Intervention.

BackgroundIn patients with non‐ST‐segment elevation acute coronary syndromes, inhibition of platelet aggregation (IPA) with a potent P2Y12 inhibitor, ticagrelor, was inferior to tirofiban infusion at 2 hours, indicating that glycoprotein IIb/IIIa inhibitors are still needed. Ticagrelor and eptifibatide bolus only may maximally inhibit platelet aggregation and decrease bleeding, but IPA with ticagrelor and eptifibatide bolus versus 2‐hour infusion is unknown.Methods and ResultsA total of 70 P2Y12‐naïve patients, with high‐risk non‐ST‐segment elevation acute coronary syndromes, were randomized to ticagrelor and eptifibatide bolus (group 1) versus ticagrelor and eptifibatide bolus with 2‐hour infusion (group 2). Levels of IPA with ADP, thrombin receptor‐activating peptide, collagen, and high on‐treatment platelet reactivity were measured by light transmission aggregometry at baseline and at 2, 6, and 24 hours after percutaneous coronary intervention in both groups. The primary end point, IPA with ADP 20 μmol/L at 2 hours, was 99.59±0.43% in group 1 versus 99.88±1.0% in group 2 (P<0.001 for noninferiority). High on‐treatment platelet reactivity with ADP was zero at 2, 6, and 24 hours in both groups. IPA levels with ADP, thrombin receptor‐activating peptide, and collagen were significantly higher at 2 and 6 hours than at 24 hours in both groups. Periprocedural myocardial infarction was not significantly different between the groups. Hemoglobin level was significantly less at 24 hours versus baseline in group 2 (13.35±1.8 versus 12.38±1.8 g/dL, respectively; P<0.01).ConclusionsTicagrelor and eptifibatide bolus maximally inhibited platelet aggregation at 2 hours, which was associated with no significant hemoglobin drop after percutaneous coronary intervention. This obviates the need for eptifibatide 2‐hour infusion and might decrease bleeding complications.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01919723.

CRT-100.21 Comparison Between Intracoronary and Intravenous Eptifibatide Bolus Injection Regimens During Primary PCI in Patients Presenting With Anterior STEMI

Eptifibatide achieves high local concentration via direct intracoronary injection as it promotes clot disaggregation, but it remains unclear if it is of superior benefit than the routine intravenous administration. The current study aimed to examine the safety and efficacy of intracoronary versus

Intracoronary thrombus formation on a guide wire: who is to blame?

Case report: A 77-year-old man with stable angina and known left main coronary artery (LMCA) disease was admitted for elective percutaneous coronary intervention (PCI). Dual antiplatelet therapy with aspirin and clopidogrel had been instituted 7 days before the PCI, accompanied by administration of unfractionated heparin (UHF) during the procedure. For the PCI planning purpose, intravascular ultrasound was performed to evaluate the anatomy and the size of the LMCA and the morphology of the left anterior descending artery-first diagonal (LAD-D1) bifurcation lesion that had appeared only moderately stenotic on angiography. Minimal lumen diameter of the middle LAD segment and LMCA was 1.6 mm and 2.6 mm, respectively, indicating the severity of both lesions. After predilatation with the semicompliant balloon, a successful provisional stenting of the LAD-D1 bifurcation lesion using drug-eluting stent (DES) was performed, followed by high-pressure postdilatation to optimize stent deployment. At that time, the thrombus formation on a guide wire within the LMCA was noted, giving rise to distal LAD embolization. Direct stenting of the proximal LMCA with DES 4.0/9 mm was then performed and the intracoronary bolus of eptifibatide was given, leading to complete LMCA thrombus resolution, with residual thrombi seen in the distal LAD segments. Due to chest pain aggravation, a second-look angiography was performed 2 hours after the index procedure, showing non-occlusive dissection at the distal end of the LMCA stent. Additional DES 4.0/9 mm was implanted with optimal result and Thrombolysis In Myocardial Infarction 3 flow. Clopidogrel was replaced with ticagrelor. The 6-month follow-up was uneventful. Discussion: Pharmacotherapy during PCI is used to mitigate the sequel of iatrogenic plaque rupture and to reduce the risk of thrombus formation on intravascular PCI equipment. Iatrogenic damage to the endothelium leads to increased expression of tissue factor and activation of the coagulation cascade, ultimately leading to thrombus formation 1

Abstract 182: The CLEAR Trials: A Pooled Analysis of rt-PA plus Eptifibatide for Treatment of Acute Ischemic Stroke

Background: The Combined approach to Lysis utilizing Eptifibatide And Rt-PA in Acute Ischemic Stroke (CLEAR), CLEAR-Enhanced Regimen (CLEAR-ER) and CLEAR-Full Dose Regimen (CLEAR-FDR) trials were phase 2 trials that examined escalating doses of recombinant tissue-type plasminogen activator (rt-PA) combined with eptifibatide in acute ischemic stroke (AIS). We pooled data from these trials and compared outcomes of the escalating doses of rt-PA plus eptifibatide to rt-PA alone. Methods: The combination arms of the CLEAR trial were: tier 1 - 0.3mg/kg of rt-PA and tier 2 - 0.45mg/kg both combined with eptifibatide 75mcg/kg bolus and 0.75mcg/kg/min for 2 hours. CLEAR-ER combined 0.6mg/kg of rt-PA and 135mcg/kg bolus of eptifibatide and 0.75mcg/kg/min for 2 hours. CLEAR-FDR combined full dose rt-PA (0.9mg/kg) and 135mcg/kg bolus of eptifibatide and 0.75mcg/kg/min for 2 hours. The control groups for both CLEAR and CLEAR-ER received full dose rt-PA only. The primary outcome was 90-day modified Rankin score (mRS) of 0-1 or return to baseline. Logistic regression was used for the analysis. Results: A total of 247 subjects were available for analysis; 69 from the combination arm of CLEAR (29 in tier 1 and 40 in tier 2), 101 from the combination arm of CLEAR-ER, and 27 from CLEAR-FDR. Fifty rt-PA only subjects (25 from CLEAR and 25 from CLEAR-ER) served as controls. Characteristics and outcomes adjusted for age, sex, race, NIHSS and time to IV rt-PA are shown in the Table. Conclusion: In the CLEAR trials, eptifibatide added to rt-PA showed a progressive increase in odds of a favorable outcome, without safety concerns. A phase 3 trial of full dose rt-PA plus the eptifibatide dose used in CLEAR-ER and CLEAR-FDR is warranted to establish the efficacy of the combination for improving AIS outcome.

Abstract TP35: Eptifibatide is Safe and May Improve Outcomes in Stroke Patients Undergoing Thrombectomy After Receiving IVtPA

Introduction: Recent trials have shown significant improvement in outcome for patients suffering from acute ischemic stroke (AIS) when mechanical thrombectomy is added to the standard of care of IV tPA. In addition to the acute anti-platelet properties eptifibatide may also reduce acute inflammatory response following neurovascular intervention. Our goal was to evaluate the potential benefit of adding IV eptifibatide to mechanical thrombectomy and IV tPA. Methods: Patients who presented to a community based university affiliated comprehensive stroke center from 2012-2015 with AIS over a 2 year period were included in the study. Only patients who received thrombectomy after IV tPA were included. A subgroup of those patients also received IV eptifibatide as a continuous drip during and after the procedure. Details of bolus dosing and duration of treatment were documented. The initial NIH Stroke Score (NIHSS) and 24-hour NIHSS were compared between the two groups with paired samples t-test using SPSS Version 22. Results: A total of 866 patients were evaluated, and 139 met the study criteria. All patients received mechanical thrombectomy after IV tPA, but 70 also received a bolus dose of 135 mcg/kg of eptifibatide followed by 0.5 mcg/kg/min continuous drip. The mean duration of the drip was 23.8 minutes (SD 14.13). There were no significant differences in complication or hemorrhage rates between groups. The mean initial minus 24-hour NIHSS (Initial-24) for the patients receiving only IV tPA/thrombectomy was 1.6. Patients who also received eptifibatide had a mean Initial-24 of 3.6. The paired mean difference was 2 (95% CI .19-3.8; p=.03), favoring the addition of eptifibatide. Conclusion: The addition of eptifibatide bolus followed by a continuous drip for a mean of 24-hours to IV tPA/thrombectomy was associated with a significantly better 24-hour post-procedure outcome. The mechanism of action may be related to the suppression of inflammation and potential prevention of rethrombosis after treatment. No additional complications were noted with eptifibatide and patients tolerated it well. A larger prospective trial is warranted to corroborate our findings.

Long-term clinical outcomes up to 7- year results of intracoronary stand-alone bolus administration of eptifibatide during coronary intervention (ice) study

Objectives: This study evaluated the immediate, intermediate and 7-year results of intracoronary (IC) eptifibatide administration during percutaneous coronary intervention (PCI). Background: Several studies tested intravenous (IV) bolus and continuous administration of eptifibatide during PCI. However, limited data is available considering giving eptifibatide as IC bolus alone during PCI. Methods: Clinical outcomes of 376 patients who received coronary stent(s) + eptifibatide by three applications during PCI and were followed up for over 84 months. Group A (119 patients) had IC eptifibatide bolus only; group B (119 patients) had IC bolus and IV infusion and group C (138 patients) had IV bolus + infusion. The standard two boluses of eptifibatide 180 mcg/kg were given either via IC or IV route and only groups B and C received IV infusion at 2 mcg/kg/min for 18-24 hours. Results: There were 256 males and 120 females, mean age 57 ± 11. Among them 52% were diabetics. The 6, 12, 24, 84-month cumulative composite endpoint of death and myocardial infraction (MI) was lower in group A (2.5%) compared to group C (10.8%, OR 4.3, p = 0.029), and group-B (5.8%, OR 2.6, p = 0.17). Compared to group-A, target vessel revascularization (TVR) was three fold in group-C (OR 3.3, p = 0.001) and two-fold in group-B (OR 2.0, p = 0.061). Bleeding was significantly higher in Group-C (OR 5.4, p < 0.0001) and Group-B (OR 3.4, p = 0.007) compared to Group-A. Re-hospitalization was significantly lower in group A (10.9%) compared to group B (16.8%) and group C (28%) (P =0.0009). Conclusion: The IC bolus alone application of eptifibatide may be safer and superior to the IV route, and continuous infusion may not be necessary. Large-scale prospective randomized trials are needed to further validate these findings.

TCT-214 Pharmacodynamic Effects of Ticagrelor and Eptifibatide Bolus-Only vs. Ticagrelor and Eptifibatide Bolus plus 2 h Infusion in Patients with Acute Coronary Syndrome

Platelet Inhibition and Patient Outcomes Trial (PLATO trial) demonstrated that aspirin and ticagrelor were superior to aspirin and clopidogrel in reducing thrombotic complications. Continuous infusion of IIb/IIIa inhibitors (GPI) was used in 40% of patients with ticagrelor in the PLATO trial.

Eptifibatide in Coronary Intervention

> You can observe a lot just by watching. > > —Yogi Berra A combination of anticoagulant and antiplatelet therapies is foundational to the safe conduct of percutaneous coronary intervention (PCI).1 This reflects the obligate disruption of coronary vessel integrity and the consequent potential for thrombosis related to PCI. Beginning over 2 decades ago, eptifibatide, an agent that blocks the glycoprotein IIb/IIIa receptor, has been evaluated in clinical trials to ameliorate the potential for PCI-related thrombosis and for improving procedural and clinical outcomes.2–7 Although the glycoprotein IIb/IIIa inhibitors have been proven to reduce thrombotic events complicating PCI (death, myocardial infarction, abrupt vessel closure, and stent thrombosis), treatment is accompanied by an increase in the incidence of bleeding events that are in turn associated with worsened cardiovascular outcomes.8–10 See Article by Gurm et al The ideal PCI antithrombotic regimen eliminates the potential for catheter and device thrombosis, maximizes the clinical efficacy of the procedure, and minimizes the risk of bleeding. The dramatic evolution in interventional device technologies of the past several decades, coupled with the availability of new antithrombotic agents, has remarkably improved procedure …

Abstract T P3: Safety of Eptifibatide after Full Dose IV tPA and Endovascular Treatment for Ischemic Stroke

Background and Objective: The safety of eptifibatide in combination with IV tPA for ischemic stroke has recently been demonstrated in the CLEAR-ER trial which used .6 mg/kg IV tPA plus eptifibatide (135 mcg/kg bolus and .75mcg/kg/min two-hour infusion) versus standard tPA (.9 mg/kg). Prior studies have also looked into the combination of intra-arterial (IA) tPA and eptifibatide at dosing and duration similar to cardiology literature. Our aim was to compare the safety and efficacy of eptifibatide after full dose IV tPA and endovascular treatment versus full dose IV tPA and endovascular treatment alone. Materials and Methods: We reviewed the records and procedure reports of patients who underwent endovascular treatment for ischemic stroke from 2010-2013 at a university affiliated comprehensive stroke center. Patients who received full dose IV tPA (.9 mg/kg) followed by endovascular treatment were compared with those who had the same treatment, but also received a bolus of 135 mcg/kg of eptifibatide followed by a .5 mcg/kg/min for 20 hours (based on IMPACT-II trial protocol). The initial and discharge NIH Stroke Scale as well as the discharge mRS (DCmRS) were evaluated. A DCmRS of 0 or 1 was considered a favorable outcome, and 2 or more was considered as a unfavorable. Initial stroke severity (NIHSS) was analyzed with logistic regression for baseline comparison and Fisher’s exact test were used for categorical data analysis. Results: We evaluated 2,016 patients with ischemic stroke, of which 230 received IV tPA and 91 (55% female) underwent endovascular treatment, 44 of them also received eptifibatide. Of the 44 patients who received eptifibatide (bolus and 20 hour infusion), 18% (n=8) had a favorable outcome, and in the group that did not receive eptifibatide , 9% (n=4) had a favorable outcome (OR=2.389, 95% CI 0.6645 to 8.589, p= 0.2217). Conclusion: Eptifibatide in combination with full dose IV tPA and endovascular treatment did not increase morbidity in our patient population, and may have improved outcome. Further, larger trials need to be conducted for more definitive results.