Extended-Infusion Eptifibatide to Prevent Stent Thrombosis in a Patient Undergoing Orthopedic Surgery

OBJECTIVE: To report the use of extended-infusion eptifibatide in a patient who had undergone placement of a drug-eluting stent and required repeat intervention of a hip fracture following mechanical failure. CASE SUMMARY: An 82-year-old female with an extensive history of coronary disease who had undergone placement of a drug-eluting stent was admitted following continued problems with her surgically repaired right hip. Radiographic imaging of the area revealed mechanical failure of the surgically repaired hip, requiring intervention. Clopidogrel and aspirin therapy was discontinued and intravenous eptifibatide 1 μg/kg/min was initiated prior to surgery; the drugs were then discontinued 4 hours before the procedure. During this admission, the patient received a total of 155 hours of eptifibatide to prevent acute coronary stent thrombosis while awaiting surgical intervention. Postoperatively, the patient experienced anemia and severe thrombocytopenia and required 11 units of packed red blood cells, but displayed no signs of stent thrombosis. DISCUSSION: Use of eptifibatide in this patient minimized the potential risk for stent thrombosis by reducing the interruption in antiplatelet therapy from 5 days, as is recommended for use with clopidogrel, to 4 hours. While this patient required several transfusions and experienced severe thrombocytopenia postoperatively, she recovered and had no cardiac-related problems. It is unclear whether the use of eptifibatide contributed to these complications, given the chronology of events. CONCLUSIONS: Extended-infusion eptifibatide appears to be an option for prevention of stent thrombosis in patients who require an interruption in antiplatelet therapy and are scheduled to undergo major orthopedic procedures. Careful consideration should be given regarding the risks and benefits of extended infusions of eptifibatide, as the potential for significant hemorrhage is a concern. Further research is warranted in this area.