Ticagrelor and Eptifibatide Bolus Versus Ticagrelor and Eptifibatide Bolus With 2‐Hour Infusion in High‐Risk Acute Coronary Syndromes Patients Undergoing Early Percutaneous Coronary Intervention

Abstract

BackgroundIn patients with non‐ST‐segment elevation acute coronary syndromes, inhibition of platelet aggregation (IPA) with a potent P2Y12 inhibitor, ticagrelor, was inferior to tirofiban infusion at 2 hours, indicating that glycoprotein IIb/IIIa inhibitors are still needed. Ticagrelor and eptifibatide bolus only may maximally inhibit platelet aggregation and decrease bleeding, but IPA with ticagrelor and eptifibatide bolus versus 2‐hour infusion is unknown.Methods and ResultsA total of 70 P2Y12‐naïve patients, with high‐risk non‐ST‐segment elevation acute coronary syndromes, were randomized to ticagrelor and eptifibatide bolus (group 1) versus ticagrelor and eptifibatide bolus with 2‐hour infusion (group 2). Levels of IPA with ADP, thrombin receptor‐activating peptide, collagen, and high on‐treatment platelet reactivity were measured by light transmission aggregometry at baseline and at 2, 6, and 24 hours after percutaneous coronary intervention in both groups. The primary end point, IPA with ADP 20 μmol/L at 2 hours, was 99.59±0.43% in group 1 versus 99.88±1.0% in group 2 (P<0.001 for noninferiority). High on‐treatment platelet reactivity with ADP was zero at 2, 6, and 24 hours in both groups. IPA levels with ADP, thrombin receptor‐activating peptide, and collagen were significantly higher at 2 and 6 hours than at 24 hours in both groups. Periprocedural myocardial infarction was not significantly different between the groups. Hemoglobin level was significantly less at 24 hours versus baseline in group 2 (13.35±1.8 versus 12.38±1.8 g/dL, respectively; P<0.01).ConclusionsTicagrelor and eptifibatide bolus maximally inhibited platelet aggregation at 2 hours, which was associated with no significant hemoglobin drop after percutaneous coronary intervention. This obviates the need for eptifibatide 2‐hour infusion and might decrease bleeding complications.Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01919723.

Clinical Evaluation of the Tolerability, Pharmacokinetics, and Inhibition of Platelet Aggregation of Eptifibatide in Healthy Chinese Subjects

“…19 Obtaining the effective dosage of eptifibatide is essential for the appropriate use of the drug. 1 Herein, we investigated the PK profile of eptifibatide and its antiplatelet aggregation in healthy Chinese subjects for the rational use of eptifibatide in the clinic. Compared with the previous studies that included healthy subjects from California, 14,20,21 the CL was slightly higher in Chinese subjects (112 mL/min for Chinese vs 95 mL/min for US subjects) and the volume of distribution (24 L for Chinese vs 20-22 L for US subjects) was similar.…”

“…The platelet GPIIb‐IIIa antagonist eptifibatide can prevent death or myocardial infarctions in patients with ACS and PCI . Obtaining the effective dosage of eptifibatide is essential for the appropriate use of the drug . Herein, we investigated the PK profile of eptifibatide and its antiplatelet aggregation in healthy Chinese subjects for the rational use of eptifibatide in the clinic.…”

“…Inhibition of platelet aggregation is an independent predictor of adverse events following percutaneous coronary intervention (PCI). 1,2 Glycoprotein (GP) IIb-IIIa inhibitors dose-dependently prevent platelet aggregation. Eptifibatide (Merck Sharp & Dohme Corp., Kenilworth, New Jersey), a GPIIb-IIIa inhibitor, has been safely and successfully used for the treatment of non-ST-segment-elevation (NTSE) acute coronary syndrome (NSTE ACS) and in patients undergoing PCI.…”

“…Inhibition of platelet aggregation is an independent predictor of adverse events following percutaneous coronary intervention (PCI) . Glycoprotein (GP) IIb‐IIIa inhibitors dose‐dependently prevent platelet aggregation.…”

Eptifibatide Bolus Dose During Elective Percutaneous Coronary Intervention

“…Although most studies have reported that bolus only or with short duration has similar outcome with lower rate of bleeding, our study did not show significant difference in MACE or bleeding rate between groups, although the rate was lower in bolus only group. However, Marian et al [ 20 ] evaluated the efficacy of ticagrelor and eptifibatide bolus versus ticagrelor and eptifibatide bolus with 2-h infusion in high-risk acute coronary syndrome (ACS) patients undergoing early PCI and observed that the maximum platelet aggregation inhibition was achieved at 2 h, with no significant bleeding indicative of the need for eptifibatide 2-h infusion. Regarding the literature, there is still need for further study to evaluate the exact dosage and protocol of eptifibatide infusion in patients undergoing elective PCI.…”