The benefit was apparent by 96 hours and persisted through 30 days. The effect was consistent in most major subgroups except for women odds ratios for death or nonfatal myocardial infarction, 0. Bleeding was more common in the eptifibatide group, although there was no increase in the incidence of hemorrhagic stroke. Conclusions: Inhibition of platelet aggregation with eptifibatide reduced the incidence of the composite end point of death or nonfatal myocardial infarction in patients with acute coronary syndromes who did not have persistent ST-segment elevation.
Also, the detection of platelet factor-4 PF-4 assay in HIT can help differentiate it from eptifibatide-induced thrombocytopenia. Eptifibatide can inhibit new platelets in both active and inactive states. Thrombocytopenia due to eptifibatide responds better after discontinuation of medication, and the addition of a platelet bag is not helpful if the patient has a high concentration of eptifibatide in plasma.
Other side effects reported include hypotension, heart failure, arrhythmias ventricular fibrillation, atrial fibrillation , hypersensitivity reactions, gastrointestinal, genitourinary, or pulmonary alveolar hemorrhage.
The contraindications to using eptifibatide mentioned below [19] :. Eptifibatide is a pregnancy category B drug. It should only be used cautiously in lactating mothers. Also, the drug is not recommended for use in the pediatric population. Bleeding at intravenous sites is the most common adverse effect.
Simultaneous use of NSAIDs or other antiplatelet drugs and renal insufficiency would increase the risk of bleeding. There is no specific antidote for eptifibatide toxicity. Eptifibatide is useful in the treatment of acute coronary syndrome ACS and following percutaneous coronary intervention PCI.
Healthcare workers, including nurses, pharmacists, and clinicians, should be aware that bleeding and thrombocytopenia are major complications following eptifibatide administration, and they should work together as a team to identify these complications.
Nursing should be first in line for monitoring for adverse events, especially bleeding, and pharmacists should conduct thorough medication reconciliation and verify dosing since medication errors in either of these areas can lead either to therapeutic failure or severe bleeding. Any concerns in these areas require immediate communication with the physician in charge, as well as the rest of the team involved in care.
Only through this type of interprofessional collaboration can patients achieve optimal therapeutic outcomes with eptifibatide. Also, since heparin is used in conjunction with eptifibatide in the treatment of ACS and during PCI, it is imperative to learn how to differentiate heparin-induced thrombocytopenia from eptifibatide-induced thrombocytopenia.
This book is distributed under the terms of the Creative Commons Attribution 4. Turn recording back on. National Center for Biotechnology Information , U. StatPearls [Internet]. Search term. Eptifibatide Agam B. Author Information Authors Agam B.
Affiliations 1 Cleveland Clinic, Ohio. In the PURSUIT trial, the eptifibatide showed favorable outcomes in reducing the composite end-point mortality and prevented nonfatal myocardial infarction in patients with non-ST elevation myocardial infarction and unstable angina.
Another possible use of eptifibatide is to enhance incidence and speed of reperfusion when used in large doses in combination with heparin, aspirin, tissue plasminogen activators in STEMI patients, as evidenced by the small group the IMPACT-AMI trial.
Mechanism of Action Rupture of atherosclerotic plaque or injury to the vessel wall exposes the subendothelial matrix of the coronary blood vessel to circulating platelets.
Administration Eptifibatide is intravenously administered and is available in strengths of 0. In such patients, abciximab is an alternative. Active internal bleeding or recent significant gastrointestinal or genitourinary bleed within the past six months. It is a strong recommendation to measure platelet count within 2 to 6 hours of administering eptifibatide to detect thrombocytopenia, if any. Serum creatinine: Since eptifibatide gets cleared renally, it is essential to monitor renal function tests.
ACT: eptifibatide is known to have an additive effect on activated clotting time ACT when used together with heparin. Toxicity Bleeding at intravenous sites is the most common adverse effect. Eptifibatide in combination with other medications The antiplatelet activity of eptifibatide was the same when coadministered with either unfractionated heparin or the LMWH enoxaparin sodium in ex-vivo studies in healthy volunteers.
Hemorrhage and thrombocytopenia In a meta analysis of the large placebo-controlled trials, major bleeding was shown to have occurred in 2. Pharmacology of eptifibatide Eptifibatide is a peptide derived from a protein found in the venom of the southeastern pygmy rattlesnake Sistrurus miliarus barbouri.
Resource utilization In the ESPRIT trial the estimated inhospital costs for each patient on the basis of hospital resource consumption procedure duration, number of stents received, length of stay , occurrence of adverse outcomes death, periprocedural acute MI, repeat PCI, inhospital coronary artery bypass graft surgery, major bleeding complications , and treatment received 58 were estimated on the basis of measured resource consumption, using a published regression model.
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Int J Angiol. Plosker GL, Ibbotson T. Spotlight on eptifibatide in percutaneous coronary intervention and acute coronary syndromes. Disease Management and Health Outcomes. Early percutaneous coronary intervention, platelet inhibition with eptifibatide, and clinical outcomes in patients with acute coronary syndromes. Enhanced efficacy of eptifibatide administration in patients with acute coronary syndrome requiring in-hospital coronary artery bypass grafting.
Anon Eptifibatide: summary of product characteristics. Available at www. Millenium Pharmaceuticals Inc and Schering Corporation, Intracoronary Stenting and Antithrombotic Regimen-Rapid Early Action for Coronary Treatment Study Investigators One year outcomes with abciximab vs placebo during percutaneous coronary intervention after pre-treatment with clopidogrel.
Dual antiplatelet therapy for coronary stenting: a clear path for a research agenda. Ann Pharmacother. Ann Emerg Med. Articles from Core Evidence are provided here courtesy of Dove Press. Support Center Support Center. External link. Please review our privacy policy. Improvement in cardiovascular morbidity and mortality. Lower risk with eptifibatide compared with placebo. Increased incidence of major and minor bleeding with add-on eptifibatide compared with standard therapy alone.
Slightly increased risk of thrombocytopenia with add-on eptifibatide compared with standard therapy alone. Increased risk of hemorrhagic stroke with add-on eptifibatide compared with standard therapy alone. Favorable for eptifibatide as an adjunct to standard care relative to standard care alone.
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