Eptifibatide and Cirrhosis: Rethinking GPIIb-IIIa Inhibitors for Acute Coronary Syndrome in the Setting of Liver Dysfunction

Abstract

Glycoprotein IIb/IIIa (GPIIb/IIIa) inhibitors, such as eptifibatide, are routinely used in the setting of acute coronary syndrome (ACS) prior to or during percutaneous coronary intervention (PCI). While numerous studies have demonstrated improved clinical outcomes with eptifibatide use, adverse effects including thrombocytopenia have also been noted. For this reason, patients with baseline thrombocytopenia or liver disease should be cautiously evaluated prior to drug administration. Here we report a case of acute profound and prolonged eptifibatide-induced thrombocytopenia in a patient with cirrhotic liver dysfunction. We propose and discuss the need for a risk stratification tool to be established for identifying which patients with ACS in the setting of chronic liver disease receive GPIIb/IIIa inhibitors.

Eptifibatide, an Older Therapeutic Peptide with New Indications: From Clinical Pharmacology to Everyday Clinical Practice

“…It is also known that bone marrow suppression or folic acid deficiency may occur in people with alcoholic cirrhosis. Accordingly, eptifibatide is contraindicated in these categories of patients [ 107 ]. We must be mindful of two other important conditions when initiating eptifibatide, namely recent major surgery or trauma within the past six weeks and a history of intracranial neoplasms, arteriovenous malformations, or aortic dissections.…”

Ischemic Heart Disease and Liver Cirrhosis: Adding Insult to Injury

“…There are only case reports regarding the use of glycoprotein IIb/IIIa inhibitors in patients with LC. Eptifibatide was associated with severe thrombocytopenia in patients with LC and an increased hemorrhagic risk [ 71 ].…”