What is the use of Eptifibatide (Integrilin)?

From the Guidelines

Eptifibatide should be administered as an initial bolus of 180 mcg/kg followed by a continuous infusion of 2 mcg/kg/min, with a reduced infusion rate of 1 mcg/kg/min in patients with renal impairment, to minimize morbidity and mortality in patients with acute coronary syndromes. The dosing regimen of eptifibatide is crucial in achieving optimal antiplatelet effects while minimizing the risk of bleeding complications 1. Key considerations in the administration of eptifibatide include:

• Initial bolus: 180 mcg/kg administered intravenously
• Continuous infusion: 2 mcg/kg/min for up to 18-24 hours after PCI
• Renal impairment: reduce infusion rate to 1 mcg/kg/min in patients with creatinine clearance <50 mL/min
• Combination therapy: often used with aspirin and heparin for maximum antiplatelet effect
• Cautious use: in patients with recent bleeding, severe hypertension, or major surgery within the past 6 weeks The evidence from the PURSUIT trial, which randomized 10,948 patients with ACS to receive eptifibatide or placebo, supports the use of eptifibatide in reducing the risk of death or nonfatal myocardial infarction 1. Additionally, the 2011 ACCF/AHA focused update on the management of patients with unstable angina/non-ST-elevation myocardial infarction provides guidance on the use of eptifibatide, including the recommended dosing regimen and precautions for use 1. The 2012 ACCF/AHA focused update incorporated into the 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction also provides valuable information on the use of eptifibatide in clinical practice 1. Overall, the use of eptifibatide as part of a comprehensive treatment strategy for acute coronary syndromes can help to improve patient outcomes and reduce the risk of morbidity and mortality.

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) (1.1) • Treatment of patients undergoing PCI (including intracoronary stenting) (1.2)

The indications for Eptifibatide are:

• Acute Coronary Syndrome (ACS): managed medically or with percutaneous coronary intervention (PCI)
• Percutaneous Coronary Intervention (PCI): including intracoronary stenting 2, 2, 2

From the Research

Eptifibatide Overview

• 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.
• It is used as an adjunct to heparin and aspirin in patients with acute coronary syndromes and/or undergoing percutaneous coronary intervention (PCI) 3, 4, 5.

Clinical Efficacy

• The PURSUIT trial showed that eptifibatide reduces the 30-day risk of death or nonfatal myocardial infarction (MI) in patients with unstable angina or non-Q-wave MI 3.
• The IMPACT-II trial demonstrated that eptifibatide reduces the 30-day risk of a combined end-point (death, nonfatal MI, and urgent or emergency coronary interventions) in patients undergoing PCI 3, 4.
• Eptifibatide has also been shown to improve epicardial flow and tissue reperfusion in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary PCI 4.

Safety and Tolerability

• The most common adverse event associated with eptifibatide therapy is bleeding, with most episodes being minor and occurring at the vascular access site 3.
• Eptifibatide is not associated with an excess of intracranial bleeds, stroke, or thrombocytopenia, and does not appear to increase bleeding risk in patients undergoing coronary artery bypass graft (CABG) 3.
• A systematic review and meta-analysis found that eptifibatide has a slightly superior safety profile compared to tirofiban in patients with acute coronary syndrome, with reduced risk of thrombolysis in myocardial infarction minor bleeding 6.

Comparison with Other Agents

• The COMPARE trial compared the anti-aggregatory effects of eptifibatide, abciximab, and tirofiban during PCI in acute coronary syndromes, and found that eptifibatide inhibited platelet aggregation most consistently throughout the treatment period 7.
• A systematic review and meta-analysis found no significant difference in efficacy between eptifibatide and tirofiban in patients with acute coronary syndrome, but suggested that eptifibatide may have a slightly superior safety profile 6.