Bleeding risk associated with eptifibatide (Integrilin) bridging in thoracic surgery patients

Abstract

Objective Antiplatelet use for treatment of coronary artery disease (CAD) is common amongst thoracic surgery patients. Perioperative management of antiplatelet agents requires balancing the opposing risks of myocardial ischemia and excessive bleeding. Perioperative bridging with short-acting intravenous antiplatelet agents has shown promise in preventing myocardial ischemia, but may increase bleeding. We sought to determine whether perioperative bridging with eptifibatide increased bleeding associated with thoracic surgery. Methods After Institutional Review Board approval, we identified thoracic surgery patients receiving eptifibatide at our institution (n=30). These patients were matched 1:2 with control patients with CAD who did not receive eptifibatide from an institutional database of general thoracic surgery patients. The primary endpoint for our study was the number of units of blood transfused perioperatively. Results There were no differences in our primary endpoint, number of units of blood products transfused. There were also no differences noted between groups in intraoperative blood loss, chest tube duration, or postoperative length of stay (LOS). While there were no difference noted in overall complications, including our outcome of perioperative MI or death, composite cardiovascular events were more common in the eptifibatide group. Conclusions In our retrospective exploratory analysis, eptifibatide bridging in patients with high-risk or recent PCI was not associated with an increased need for perioperative transfusion, bleeding, or increased LOS. In addition, we found a similar rate of perioperative mortality or myocardial infarction in both groups, though the ability of eptifibatide to protect against perioperative myocardial ischemia is unclear given different baseline CAD characteristics.

Efficacy and safety of a bridging strategy that uses intravenous platelet glycoprotein receptor inhibitors for patients undergoing surgery after coronary stent implantation: a meta-analysis

“…Among them, 6 studies [ 11 , 12 , 14 , 16 – 18 ] included 215 patients that used tirofiban for bridging therapy. Four studies [ 13 , 15 , 19 , 20 ] had 167 patients that used eptifibatide for bridging therapy.…”

Antiplatelet Therapy Bridging With Cangrelor in Patients With Coronary Stents: A Case Series

“…Reports of the use of abciximab and tirofiban prior to surgical procedures have shown higher rates of intraoperative bleeding with these agents, although recent reports found that a dose of 2 µg/kg/min of eptifibatide (reduced in impaired renal function) infused after stent implantation as a bridge to surgery did not cause excessive bleeding events or stent thrombosis. [17][18][19][20][21] Advantages of cangrelor over eptifibatide for this purpose may include more rapid drug elimination, allowing a shorter preprocedural washout period, and potentially lower drug costs with the dosing regimen of cangrelor described within this experience. 1,22 Table 3 provides cost comparisons with cangrelor at doses of 0.5 and 0.75 µg/kg/min with that of eptifibatide 2 µg/kg/min, based on a patient weight of 80 kg and median duration of cangrelor therapy of 5 days using average wholesale prices.…”

Safety and Efficacy of Periprocedural Bridging With Cangrelor Versus Eptifibatide

“…6 A small, retrospective, single-center study analyzed the use of eptifibatide as a bridging agent in patients with recent or high-risk PCI on DAPT awaiting thoracic surgery. 7 The outcomes assessed the number of units of blood transfused during the periprocedural period, MACE, and postoperative complications (cardiovascular complications, reintubations, reoperations, renal failure, or confusion). Periprocedural bridging with eptifibatide was not associated with an increased risk of bleeding defined by the number of blood transfusion when compared with patients who did not undergo bridging.…”