From the Guidelines
Eptifibatide is an antiplatelet medication that inhibits platelet aggregation by blocking glycoprotein IIb/IIIa receptors on platelets, and its use is recommended in acute coronary syndromes and during percutaneous coronary interventions (PCI) to reduce the risk of ischemic complications, as supported by the most recent and highest quality study 1.
Key Points
- Eptifibatide is primarily used in acute coronary syndromes (unstable angina or non-ST elevation myocardial infarction) and during PCI.
- The standard dosing regimen includes an initial bolus of 180 mcg/kg intravenously, followed by a continuous infusion of 2 mcg/kg/min for up to 72 hours for acute coronary syndromes or 18-24 hours after PCI.
- Dose adjustment is necessary for patients with renal impairment (creatinine clearance <50 mL/min).
- Common side effects include bleeding complications, which can range from minor bruising to major hemorrhage.
- Before administration, baseline complete blood count, coagulation studies, and renal function should be assessed.
- Eptifibatide works by preventing fibrinogen from binding to activated platelets, thus preventing the formation of platelet-rich thrombi that can cause vessel occlusion and subsequent ischemic events.
- It is often used in combination with aspirin and heparin for maximum antiplatelet and antithrombotic effect in acute coronary settings.
Clinical Use
- The use of eptifibatide in patients with acute coronary syndromes and during PCI has been shown to reduce the risk of ischemic complications, including death, myocardial infarction, and urgent revascularization 1.
- The EARLY ACS trial demonstrated that early routine administration of eptifibatide was not superior to delayed provisional administration in reducing ischemic complications among high-risk patients with UA/NSTEMI, but was associated with a greater risk of bleeding complications 1.
- The ESPRIT trial showed that eptifibatide treatment as adjunctive therapy during nonemergency coronary stent implantation reduced the 48-h primary composite end point of death, MI, urgent target-vessel revascularization, or bailout treatment with open-label GP IIb/IIIa inhibitor therapy by 37% 1.
From the FDA Drug Label
Eptifibatide injection is a platelet aggregation inhibitor indicated for: • Treatment of acute coronary syndrome (ACS) managed medically or with percutaneous coronary intervention (PCI) • Treatment of patients undergoing PCI (including intracoronary stenting)
The use of Eptifibatide (Integrilin) is for:
- Treatment of acute coronary syndrome (ACS) managed medically or with percutaneous coronary intervention (PCI)
- Treatment of patients undergoing PCI (including intracoronary stenting) 2 2 2
From the Research
Use of Eptifibatide (Integrilin)
- Eptifibatide is a highly specific, intravenously administered glycoprotein (GP) IIb/IIIa receptor antagonist that prevents fibrinogen binding to the GP IIb/IIIa receptor, inhibiting platelet aggregation and preventing thrombus formation 3, 4, 5.
- Clinically, the drug is used as an adjunct to heparin and aspirin in patients with acute coronary syndromes and/or undergoing percutaneous coronary intervention (PCI) 3, 6, 5.
- The use of eptifibatide has been shown to reduce the risk of death or nonfatal myocardial infarction in patients with unstable angina or non-Q-wave myocardial infarction (MI) 3, 4, 5.
- Eptifibatide is also effective in patients undergoing PCI, reducing the risk of thrombotic complications and improving epicardial flow and tissue reperfusion 4, 6, 5.
- The safety of eptifibatide is slightly superior to tirofiban in patients with acute coronary syndrome, with a reduced risk of thrombolysis in myocardial infarction minor bleeding 7.
- The choice of eptifibatide depends on the situation of use, patient-specific characteristics, and risk stratification, as well as the chosen management strategy (medical management or intervention) 6.
Clinical Settings
- Eptifibatide is used in the following clinical settings:
- Eptifibatide is not recommended for routine use in patients undergoing PCI with low risk (e.g., elective stenting), but is a reasonable first-line option for patients with higher risk 6.