Abbreviated Infusion of Eptifibatide After Successful Coronary Intervention

Fung, Anthony; Saw, Jacqueline; Starovoytov, Andrew; Densem, Cameron G.; Jokhi, Percy; Walsh, Simon; Fox, Rebecca; Humphries, Karin H.; Aymong, Eve; Ricci, Donald R.; Webb, John G.; Hamburger, J; Carere, Ronald G.; Buller, Christopher E.

doi:10.1016/j.jacc.2008.09.060

Cited by 59 publications

(15 citation statements)

References 35 publications

(25 reference statements)

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“…A GPI bolus or 2‐hour infusion with clopidogrel, as compared with a GPI infusion for 12 to 18 hours, decreased bleeding complications with no difference in outcomes 7, 8. Furthermore, Gurm et al20 analyzed 21 296 patients; of these, 4511 were treated with eptifibatide bolus at the time of PCI and 16 785 received standard therapy (bolus plus infusion).…”

Section: Discussionmentioning

confidence: 99%

“…In this respect, future studies are needed to compare the PD effect of ticagrelor and eptifibatide bolus with ticagrelor and unfractionated heparin/bivalirudin. Third, because clopidogrel and eptifibatide 18‐ versus 2‐hour infusion increased bleeding,8 we did not randomize patients to ticagrelor and eptifibatide 18‐ versus 2‐hour infusion. Fourth, because it has been demonstrated23 that the vasodilator‐stimulated phosphoprotein assay had minor differences as compared with the LTA measurements, we did not perform the vasodilator‐stimulated phosphoprotein assay to measure platelet reactivity index.…”

Section: Discussionmentioning

confidence: 99%

“…Despite the well‐established anti‐ischemic effect of GPI, an extended infusion of GPI was associated with increased risk of bleeding and mortality 6. On the other hand, a number of series reported that the rate of bleeding significantly decreased with a bolus or short infusion of GPI 7, 8. Ticagrelor and eptifibatide bolus, as compared with ticagrelor and eptifibatide 2‐hour infusion, might maximally inhibit platelet aggregation and reduce the risk of bleeding.…”

Section: Introductionmentioning

confidence: 99%

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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

Marian

Alli

Solaiman

et al. 2017

JAHA

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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.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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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

Marian

Alli

Solaiman

et al. 2017

JAHA

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“…Inadequate PI to either clopidogrel or ticlopidine at steady state was common, but nonresponse to both drugs was infrequent (3.5%), suggesting that inadequate PI is drug specific rather than class specific. Angiolillo et al (135) (137). The primary end point, incidence of ischemic injury, was 30.1% in the short group and 28.3% in the standard group.…”

Section: Pharmacotherapymentioning

confidence: 96%

The Year in Interventional Cardiology

Dixon¹,

Grines²,

O’Neill³

2008

Journal of the American College of Cardiology

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“…[5][6][7] It is unclear, however, as to how long platelet inhibition must be maintained after contemporary PCI, and a small randomized study previously suggested that an eptifibatide bolus and a short infusion (<2 hours) were noninferior to the standard regimen of bolus plus infusion and might be associated with a reduction in bleeding. 8 …”

mentioning

confidence: 99%

Comparative Effectiveness and Safety of a Catheterization Laboratory–Only Eptifibatide Dosing Strategy in Patients Undergoing Percutaneous Coronary Intervention

Gurm

Hosman

et al. 2015

Circ: Cardiovascular Interventions

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Background-Eptifibatide, a small-molecule glycoprotein IIb/IIIa inhibitor, is conventionally administered as a bolus plus infusion. A growing number of clinicians are using a strategy of catheterization laboratory-only eptifibatide (an off-label use) as procedural pharmacotherapy for patients undergoing percutaneous coronary intervention although the comparative effectiveness of this approach is unknown. Methods and Results-We compared the in-hospital outcome of patients undergoing percutaneous coronary intervention across 47 hospitals and treated with eptifibatide bolus plus infusion with those treated with a catheterization laboratoryonly regimen. We used optimal matching to link the use of catheterization laboratory-only eptifibatide with clinical outcomes, including mortality, myocardial infarction, bleeding, and need for transfusion. Of the 84 678 percutaneous coronary interventions performed during 2010 to 2011, and meeting our inclusion criteria, eptifibatide was administered to 21 296 patients. Of these, a catheterization laboratory-only regimen was used in 4511 patients, whereas 16 785 patients were treated with bolus plus infusion. In the optimally matched analysis, compared with bolus plus infusion, a catheterization laboratory-only regimen was associated with a reduction in bleeding (optimally matched adjusted odds ratio, 0.74; 95% confidence interval, 0.58-0.93; P=0.014) and need for transfusion (optimally matched adjusted odds ratio, 0.70; 95% confidence interval, 0.52-0.92; P=0.012), with no difference in mortality or myocardial infarction. Conclusions-A catheterization laboratory-only eptifibatide regimen is commonly used in clinical practice and is associated with a significant reduction in bleeding complications in patients undergoing contemporary percutaneous coronary intervention. (Circ Cardiovasc Interv. 2015;8:e001880.

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Abbreviated Infusion of Eptifibatide After Successful Coronary Intervention

Cited by 59 publications

References 35 publications

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

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

The Year in Interventional Cardiology

Comparative Effectiveness and Safety of a Catheterization Laboratory–Only Eptifibatide Dosing Strategy in Patients Undergoing Percutaneous Coronary Intervention

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