Platelet glycoprotein IIb/IIIa inhibition using eptifibatide with primary coronary stenting for acute myocardial infarction: A 30‐day follow‐up study

Abstract

The results of primary coronary stenting for acute myocardial infarction (AMI) have been reported to improve significantly with the concomitant administration of platelet glycoprotein IIb/IIIa inhibitor abciximab. There are, however, no data available with the use of eptifibatide, a more cost-effective, small-molecule GP IIb/IIIa blocker with a shorter half-life. In a prospective multicenter feasibility and efficacy study, we assigned 55 consecutive patients with AMI being taken up for primary stenting to receive eptifibatide just before the procedure (two boluses of 180 microg/kg 10 min apart and a 24-hr infusion of 2 microg/kg/min). Clinical outcomes were evaluated at 30 days after the procedure. The angiographic patency of the vessel with TIMI flow rates, TIMI myocardial perfusion (TMP) grade, and corrected TIMI frame counts were assessed at the end of procedure and before hospital discharge. At 30 days, the primary endpoint, a composite of death, myocardial infarction, and urgent target vessel revascularization (TVR) was seen in 12.7% of patients. The TIMI 3 and TMP grade 3 flow, which was seen in 93% and 86% of patient, respectively, at the end of the procedure, declined to 86% and 78%, respectively (P < 0.05) before hospital discharge. Corrected TIMI frame counts also decreased from 25.7 +/- 7.2 to 22.9 +/- 6.8 (P < 0.05). There were five (9.1%) instances of subacute thrombosis (SAT) presenting as AMI, needing urgent TVR in all, within 3-5 days of the primary procedure. No excessive bleeding complication, directly attributable to the use of eptifibatide, was observed. The study was terminated prematurely because of an unacceptable SAT rate. Administration of eptifibatide along with primary stenting for AMI is associated with a high TIMI 3 and TMP grade 3 flow acutely. However, these flows decline significantly before hospital discharge and lead to a high rate of SAT. The dosage and duration of infusion of eptifibatide in this setting needs further evaluation.

Rescue Revascularization Therapy With a Stent-in-Stent Technique for Acute Intracranial Internal Carotid Artery Occlusion-Case Report-

“…The antiplatelet agent abciximab, a glycoprotein IIb/IIIa receptor antagonist, can reduce thrombogenic complications; it is commonly used in coronary stenting in North America and Europe. 3,4,[7][8][9]11,12,14,17) Unlike other antiplatelet agents, abciximab, which blocks the action Stent-in-Stent Technique for Revascularization of ICA Occlusion of fibrinogen and the von Willebrand factor at the glycoprotein IIb/IIIa receptor, acts quickly. However, as its use is not yet approved in Japan, we used ozagrel sodium (thromboxane A 2 inhibitor) and ticlopidine.…”

Glycoprotein IIb/IIIa Inhibitors in Patients Undergoing Percutaneous Mechanical Intervention for Acute Myocardial Infarction

“…A small feasibility and efficacy study based on 55 patients with ST-segment elevation AMI treated by infarct artery stenting and double bolus and 24 h infusion of eptifibatide was stopped prematurely because of an unacceptable subacute stent thrombosis rate (9.1%) [32]. It has been speculated that the short glycoprotein IIb/IIIa inhibition provided by the drug could lead to a rebound prothrombotic state favoring stent thrombosis.…”

Medical Treatment of Patients with Heart Failure or Left Ventricular Dysfunction Undergoing Percutaneous Coronary Intervention

“…withdrawal is based on the complexity of PCI, but we generally Abciximab [94,95] and eptifibatide [96] have been evaluated in the discontinue use upon leaving the laboratory to limit bleeding setting of STEMI, and abciximab has been shown to benefit complications. patients.…”