Complications and Management of Eptifibatide-Induced Thrombocytopenia

Abstract

Background Eptifibatide is used in acute coronary syndromes to reversibly block platelet aggregation by inhibiting the platelet glycoprotein IIb/IIIa receptor. A serious adverse effect of eptifibatide is a profound drop in platelet count, termed eptifibatide-induced thrombocytopenia (EIT). Objective To provide insight into the types of complications and management of EIT. Methods Cases of EIT submitted to the Food and Drug Administration adverse event reporting system were evaluated. Data analyses included management of EIT, complications of thrombocytopenia, initial platelets, and platelet nadir following eptifibatide. Results 103 cases of EIT were reported from January 2010 to 2019; 57 cases met the Naranjo scale and were included. Only 37 of those cases contained information on how EIT was managed. Eptifibatide administration was withheld in all 37 of those cases. Platelet transfusions were administered in 20 cases (54%). Two cases were managed with steroids (5.4%), and 1 case used intravenous immunoglobulin G to reverse EIT (2%). The median initial platelet count prior to administration of eptifibatide was 207 000 cells/mm3 (SD = 69 000; n = 27), and median platelet nadir was 9000 cells/mm3 (SD = 19 000; n = 35) The majority of complications of EIT included bleeding events (16/28, 57%). Delayed procedures, prolonged stay, allergic reactions, and thrombosis were each reported in 3 patients (10.75%). Conclusion and Relevance Most cases of EIT were managed by withholding eptifibatide with platelet transfusion if necessary. The majority of complications included bleeding. However, significant procedure delays, prolonged hospital stay, thrombosis, and allergic reactions were also reported.

Eptifibatide-Induced Severe Thrombocytopenia After ST-Elevation Myocardial Infarction (STEMI): A Case Report

“…Most patients develop minor bleeding, including petechiae or trivial bleeding from catheter sites. However, major bleeding, such as gastrointestinal bleeding or hematuria, has been reported, and some patients developed life-threatening bleeding necessitating further management [6,7].…”

Critical Analysis of Thrombocytopenia Associated With Glycoprotein IIb/IIIa Inhibitors and Potential Role of Zalunfiban, a Novel Small Molecule Glycoprotein Inhibitor, in Understanding the Mechanism(s)

“…Masood et al reported on 57 cases of eptifibatide‐induced thrombocytopenia identified in the US Food and Drug Administration adverse reporting system. 44 The mean (±SD) nadir in 35 patients was 9000±19 000 platelets/μL. Bleeding symptoms were present in 57% of cases and included bleeding from the catheterization site (14%), petechial hemorrhages (14%), groin hematomas (7%), bleeding from infusion site (7%), gastrointestinal bleeding (3.6%), hemoptysis (3.6%), epistaxis (3.6%), and hematuria (3.6%).…”

Eptifibatide, an Older Therapeutic Peptide with New Indications: From Clinical Pharmacology to Everyday Clinical Practice

“…Treatment options for EIT include stopping the infusion, platelet transfusions (which may be inefficient because of the half-life of GPI), and fresh frozen plasma (used in major bleeding). Other treatment options include the use of corticosteroids (which are not effective) and intravenous immunoglobulin G (IVIG) [ 117 ].…”

“…Masood et al showed that out of 28 reported complications of EIT, 57% involved bleeding events. These included 14% catheterization site bleeding, 14% petechial hemorrhage, 7% groin hematoma, 7% infusion site bleeding, 3.6% gastrointestinal bleeding, 3.6% hemoptysis, 3.6% epistaxis, and 3.6% hematuria [ 117 ]. Diffuse alveolar hemorrhage (DAH) is another important but often underappreciated form of eptifibatide-related bleeding.…”

“…The following side effect also occurred in some proportion, namely allergic reactions such as rigor, chills, angioedema, and hypotension. Positive eptifibatide antibodies were also found in 87.5% of cases [ 81 , 117 ].…”