What is the dosing regimen for intravenous (IV) eptifibatide (integrillin) in acute coronary syndrome?

IV Eptifibatide (Integrilin) Dosing Regimen in Acute Coronary Syndrome

For patients with acute coronary syndrome, the recommended dosing regimen for IV eptifibatide is a 180 mcg/kg bolus followed by a 2.0 mcg/kg/min infusion, with a second 180 mcg/kg bolus given 10 minutes after the first bolus. 1

Dosing Details

Acute Coronary Syndrome (UA/NSTEMI)

• Initial bolus: 180 mcg/kg administered intravenously
• Second bolus: 180 mcg/kg given 10 minutes after the first bolus
• Continuous infusion: 2.0 mcg/kg/min
• Duration: 18-24 hours after PCI or until hospital discharge, whichever comes first 1

During Percutaneous Coronary Intervention (PCI)

• Same dosing as above
• The infusion can be continued for an additional 24 hours if an intervention is performed near the end of the initial infusion period 2
• Total duration should not exceed 96 hours 1

Clinical Evidence Supporting This Dosing

The ESPRIT trial demonstrated that this double-bolus regimen with a 2.0 mcg/kg/min infusion significantly reduced the 48-hour primary composite endpoint of death, MI, urgent target-vessel revascularization, or bailout treatment by 37% (from 10.5% to 6.6%, p=0.0015) compared to placebo. 1

This benefit was maintained at 30 days with a 35% reduction in the composite endpoint of death, MI, and urgent target-vessel revascularization (from 10.4% to 6.8%, p=0.0034). 2

Earlier studies using lower doses (135 mcg/kg bolus followed by 0.5 mcg/kg/min infusion) showed less robust results, confirming that the higher dose regimen is more effective. 1, 3

Adjunctive Therapy

• Eptifibatide should be administered with:
  • Aspirin (162-325 mg initially, then 75-162 mg daily for long-term therapy)
  • Heparin (60 units/kg bolus, not to exceed 6000 units)
  • Additional heparin boluses may be given to maintain ACT between 200-300 seconds 1

Special Considerations

• Renal impairment: For patients with creatinine clearance <50 mL/min, reduce the infusion rate to 1.0 mcg/kg/min while maintaining the standard bolus doses
• Discontinuation before CABG: Stop infusion 2-4 hours before surgery 2
• Monitoring: Regular assessment of platelet counts is recommended to detect thrombocytopenia

Contraindications and Precautions

• Active bleeding or history of bleeding within previous 30 days
• Severe hypertension (systolic BP >200 mmHg or diastolic BP >110 mmHg)
• Major surgery within preceding 6 weeks
• Stroke within 30 days or any history of hemorrhagic stroke
• Current or planned use of another parenteral GP IIb/IIIa inhibitor
• Platelet count <100,000/mm³

Clinical Context

Eptifibatide has been approved for the treatment of patients with ACS (UA/NSTEMI) who are treated medically or with PCI. 2 The drug works by inhibiting the glycoprotein IIb/IIIa receptor on platelets, preventing platelet aggregation and thrombus formation.

The PURSUIT trial, which enrolled 10,948 patients with chest pain at rest within the previous 24 hours and ST-T changes or CK-MB elevation, demonstrated that eptifibatide reduced the primary outcome of death or nonfatal MI at 30 days from 15.7% to 14.2% (p=0.042). 2

Remember that eptifibatide has a short half-life, with platelet function recovering within 2-4 hours after cessation of therapy, which can be advantageous if urgent surgery becomes necessary. 2