Clinical and economic studies of eptifibatide in coronary stenting

Abstract

Platelet adhesion and aggregation at the site of coronary stenting can have catastrophic clinical and economic consequences. Therefore, effective platelet inhibition is vital during and after percutaneous coronary intervention. Eptifibatide is an intravenous antiplatelet agent that blocks the final common pathway of platelet aggregation and thrombus formation by binding to glycoprotein IIb/IIIa receptors on the surface of platelets. In clinical studies, eptifibatide was associated with a significant reduction of mortality, myocardial infarction, or target vessel revascularization in patients with acute coronary syndrome undergoing percutaneous coronary intervention. However, recent trials conducted in the era of dual antiplatelet therapy and newer anticoagulants failed to demonstrate similar results. The previously seen favorable benefit of eptifibatide was mainly offset by the increased risk of bleeding. Current American College of Cardiology/American Heart Association guidelines recommend its use as an adjunct in high-risk patients who are undergoing percutaneous coronary intervention with traditional anticoagulants (heparin or enoxaparin), who are not otherwise at high risk of bleeding. In patients receiving bivalirudin (a newer safer anticoagulant), routine use of eptifibatide is discouraged except in select situations (eg, angiographic complications). Although older pharmacoeconomic studies favor eptifibatide, in the current era of P2Y12 inhibitors and newer safer anticoagulants, the increased costs associated with bleeding make the routine use of eptifibatide an economically nonviable option. The cost-effectiveness of eptifibatide with the use of strategies that decrease the bleeding risk (eg, transradial access) is unknown. This review provides an overview of key clinical and economic studies of eptifibatide well into the current era of potent antiplatelet agents, novel safer anticoagulants, and contemporary percutaneous coronary intervention.

Novel stable cytokine delivery system in physiological pH solution: chitosan oligosaccharide/heparin nanoparticles

“…1 Of these diseases, myocardial infarction, one of the leading causes of mortality, is the most common and difficult to treat in the clinic, because cardiomyocytes are not able to regenerate. 2 Tissue regeneration through stem/ progenitor cells has been studied extensively in a wide range of tissue repair applications, especially for regeneration of cardiomyocytes, owing to the unique pluripotency and regenerative properties of these cells. 3,4 However, tissue regeneration involves a series of biological processes, including mobilization of stem cells, angiogenesis, and…”

PEAR1 gene polymorphism in a Chinese pedigree with pulmonary thromboembolism

“…[22,23] The contributions of the PEAR1 gene to the activation of platelets, inhibition of platelet progenitor cell proliferation, and interruption of platelet aggregation have been revealed. [9,11,12,22] …”

Eptifibatide Bolus Dose During Elective Percutaneous Coronary Intervention

“…However, stenting causes platelet activation and aggregation that can lead to catastrophic thrombotic complications. Various antiplatelet agents that block different pathways in platelet activation and aggregation, have been introduced and used for preventing cardiovascular events after coronary stenting [ 4 ]. Eptifibatide is a platelet glycoprotein IIb/IIIa (GP IIb/IIIa) receptor antagonist that inhibits fibrinogen binding to the activated GP IIb/IIIa site which prevents platelet-platelet interaction and clot formation [ 5 ].…”