Treatment of progressive ischemic stroke with low‑dose eptifibatide: A retrospective case‑control study

Abstract

Progressive ischemic stroke (PIS) is a therapeutic challenge in clinical practice. The present retrospective study aimed to investigate the safety and effectiveness of eptifibatide in the treatment of PIS. The present study enrolled patients with PIS admitted to Xiangtan Central Hospital (Xiangtan, China) between March 2020 and March 2021 with National Institutes of Health Stroke Scale (NIHSS) progression scores of ≥2 points during the initial 72 h. Patients were then divided into two groups according to their different anti-platelet treatment regimens. The control group was administered anti-platelet aggregation with aspirin 100 mg/day, or aspirin 100 mg/day in combination with clopidogrel 75 mg/day, whilst eptifibatide was administered in the eptifibatide group in addition to the treatment regimen used in the control group. Changes in NIHSS scores at the time of progression and 7 days after treatment (∆NIHSS) were used to assess early neurological recovery, and there were no significant differences in ∆NIHSS and adverse reactions between the groups (P>0.05). Subgroup analysis was subsequently performed according to the type of blood vessel that was involved [large artery atherosclerosis (LAA) or small artery occlusion (SAO)]. For the SAO subgroup, the ∆NIHSS in the eptifibatide group was significantly superior to that of the control group (P= 0.008), while for the LAA subgroup, there were no significant differences in ∆NIHSS between groups (P=0.334). The present retrospective study found that patients with PIS tolerated eptifibatide treatment well. Eptifibatide exerted different effects on patients with acute PIS involving different types of blood vessels compared with oral antiplatelet drugs. In addition, application of eptifibatide may lead to faster and earlier recovery in patients with SAO, but not in those with LAA. Low-dose eptifibatide is a safe and effective treatment option for patients with PIS caused by SAO.

Safety and Efficacy of Low-Dose Eptifibatide for Tandem Occlusions in Acute Ischemic Stroke

“…Perhaps, these better clinical outcomes in the eptifibatide group resulted from lower rates of thrombotic and hemorrhagic complications in comparison with patients not receiving this drug (even if these differences in our material were not statistically significant). Theoretically, these differences could be associated with fewer thrombotic occlusions in the cerebral microvasculature [16,[22][23][24]. Of note, reocclusion of the ICA or suboptimal thrombectomy are independent predictors of the intracranial bleeding in the settings of ischemic stroke [16,26].…”

“…Of note, reocclusion of the ICA or suboptimal thrombectomy are independent predictors of the intracranial bleeding in the settings of ischemic stroke [16,26]. In the study by Renu et al, it was found that the highest rate of bleeding complications occurred in the group in which stent implantation was used in combination with antiplatelet drug, but there was either a suboptimal intracranial recanalization (TICI ≤ 2a) or there was stent thrombosis [23]. Probably, incomplete recanalization and damage to the blood-brain barrier, in combination with the antiplatelet drugs, increased the risk of intracranial bleeding [26].…”

“…Yet, data regarding the safety and efficacy of early administration of eptifibatide in this particular group of stroke patients are scarce and inconclusive [18,19,[21][22][23]. Moreover, according to the producer, this pharmacological agent is contraindicated in stroke patients; thus, all published reports on eptifibatide in stroke patients concern its off-label administration.…”

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

“…The FDA indicates its use for the treatment of ACS and in percutaneous coronary intervention (PCI) [ 68 ]. However, research over the past decade has also sought to evaluate the role of eptifibatide in ischemic stroke, stenting of carotid and intracranial aneurysms, and septic shock [ 68 , 69 , 70 , 71 , 72 , 73 ]. In Table 2 we present summary of recently published meta-analyses.…”

“…A newer retrospective case-control study by Luo et al (2022) compared routine therapy and treatment with an additional low dose of eptifibatide. Although the study reported no significant differences in NIHSS or adverse events, an analysis of the subgroups showed that eptifibatide is a safe and effective treatment when small artery occlusion is involved [ 71 ]. Similarly, a trial by Rana et al from 2022 showed that using eptifibatide during endovascular therapy in large vessel occlusion is associated with a higher rate of hemorrhages and no benefits to the NIHSS or 90-day mortality [ 101 ].…”