Catherine To, PharmD
Memorial Hermann - Texas Medical Center
Houston, Texas
Disclosure information not submitted.
Teresa Allison, BCCCP, BCPS, PharmD
Clinical Pharmacist Specialist
Memorial Hermann Texas Medical Center, United States
Disclosure information not submitted.
Sarah Brinson, PharmD,
Clinical Pharmacist
Memorial Hermann Texas Medical Center, United States
Disclosure information not submitted.
Title: Safety of reduced dose eptifibatide in acute ischemic stroke patients
Introduction: Eptifibatide is dosed at 180 mcg/kg bolus followed by 2 mcg/kg/min after PCI. Current literature suggests this may be an appropriate dose in acute ischemic stroke (AIS). However, our institution typically uses 90 mcg/kg followed by 1 mcg/kg/min. The purpose of this study is to assess the safety of reduced-dose eptifibatide in AIS patients.
Methods: This is a single center, retrospective cohort analysis of patients 18 years or older with AIS and received eptifibatide from 7/18 to 7/21. Patients who developed an in-hospital stroke, were pregnant, or a prisoner were excluded. Safety of eptifibatide was assessed by major bleeding defined as hemoglobin drop ≥ 2 g/dL, required at least 1 transfusion associated with eptifibatide use, or new ICH within 72 hours of eptifibatide. All results presented as descriptive statistics.
Results: Thirty-three patients were included; median (IQR) age was 66 (58, 73) years, median (IQR) NIHSS was 13 (5, 20), and 33% were taking an antiplatelet. Vessel occlusion occurred in the MCA (55%), ICA (39%), and basilar artery (6%). Indications for eptifibatide were stent placement (94%) and medical management (6%). Twenty-seven patients (82%) received a bolus of 90 mcg/kg, while 6 received more or less than the 90 mcg/kg bolus. Twenty-five patients (76%) received a rate of 1 mcg/kg/min, while 8 received between 0.5 to 0.75 mcg/kg/min and 2 patients received 1.5 mcg/kg/min. The median (IQR) infusion duration was 19 (16, 25) hours. Two (6%) patients experienced major bleeding. One patient developed a new subarachnoid hemorrhage and one patient had a small hemorrhagic conversion; neither affected patient outcomes. Twelve patients received alteplase on admission; of these one experienced a major bleeding event. Post-eptifibatide infusion, 29 patients received dual antiplatelet therapy with aspirin and clopidogrel, while 4 patients received aspirin or a P2Y12 inhibitor. The majority of patients went home or to rehab (88%).
Conclusions: The use of reduced-dose eptifibatide in stroke patients has not been well studied. These results suggest the use of eptifibatide in AIS may be safe, however, the study is limited by the small patient population. More research is required to determine significance in adverse effects and of eptifibatide in this patient population.