FDA (US): Approved (1998, Integrilin) for acute coronary syndrome and percutaneous coronary intervention
EMA (EU): Approved (1999, Integrilin) to prevent early heart attack in unstable angina or non-ST-elevation heart attack
Dose
Acute coronary syndrome: IV bolus of 180 µg/kg and then infusion of 2 µg/kg/min for up to 72 h; in angioplasty a second 180 µg/kg bolus is added at 10 min (FDA prescribing information). Reduce the infusion to 1 µg/kg/min if creatinine clearance is <50 ml/min.
Safety
Main risk: bleeding, including severe bleeding. Can sharply lower platelets (acute thrombocytopenia). Contraindicated with active bleeding, recent stroke, severe uncontrolled hypertension, or dialysis. Hospital use only and under medical supervision.
Interactions
Higher bleeding risk with heparin, anticoagulants, thrombolytics, and other antiplatelets; do not combine with another GP IIb/IIIa inhibitor.
Differences between women and men
In a meta-analysis of 6 trials of GP IIb/IIIa inhibitors (31,402 patients with acute coronary syndrome), men benefited (OR 0.81 for death or infarction) and women did not (OR 1.15). The difference disappeared after accounting for troponin: women and men with elevated troponin did benefit. View the study →
Effect by goal · level of evidence
Less death or infarction after stent implantation
reducesHighRCT (AA)in people
−37% death/infarction
In the ESPRIT trial (2,064 patients with elective stenting), eptifibatide reduced death or infarction at 6 months from 11.5% to 7.5%.
It blocks the platelet GP IIb/IIIa receptor, which is the final pathway by which platelets bind to each other through fibrinogen. This prevents the platelet clot from forming in a damaged coronary artery. Its effect wears off within a few hours after the infusion is stopped.
What the evidence says
In people
Less death or heart attack after stent placement. In the ESPRIT trial (2,064 patients with elective stenting), eptifibatide reduced death or heart attack at 6 months from 11.5% to 7.5%. PubMed 11368699
Acute coronary syndrome: modest benefit with more bleeding. With GP IIb/IIIa inhibitors, death or heart attack at 30 days fell from 11.8% to 10.8%, but major bleeding rose from 1.4% to 2.4%. PubMed 11812552